Why the study?
Annular rupture is a rare, fatal TAVR complication, but rupture resulting specifically from a calcified nodule in the left ventricular outflow tract is not commonly reported.
Protamine sulfate administration successfully managed a rare annular rupture caused by a calcified LVOT nodule during TAVR.
LV calcified nodule may trigger annular rupture in TAVR; leaves open optimal imaging and sizing strategies.
Annular rupture is a rare yet fatal complication of transcatheter aortic valve replacement (TAVR). The likelihood of annular rupture is increased by the presence of extensive subannular calcification, excessive balloon dilatation for valve expansion or aggressive valve oversizing to prevent paravalvular leakage during TAVR. Although extensive annular or aortic root calcification increases the likelihood of annular rupture, rupture due to the presence of a calcified nodule in the left ventricular outflow tract (LVOT) is not commonly reported. We present the case of an 84-year-old man who developed an annular rupture during TAVR, likely due to the presence of a calcified nodule located in LVOT, which was noted on a pre-procedural computed tomography (CT) scan. The rupture was identified early and was successfully reversed with the administration of protamine sulfate during the procedure.
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Chauhan et al. (2023) studied this question.
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