Backed Against a Wall: Iatrogenic Type A Aortic Dissection Pinned by Transcatheter Aortic Valve

Figures

• 

  Figure 1. Iatrogenic aortic root dissection. (a) Cardiac CT: bicuspid aortic valve and (b) Heavy calcifications within aortic annulus and LVOT; (c) Aortogram: sinotubular aortic dissection during TAVR deployment; (d) Postdeployment aortogram: dissection pinned by TAVR cage; (e and f) Postprocedure CTA: sinotubular dissection; (g) 6-week follow-up CTA: stable dissection flap without extension. Abbreviations: CT, computed tomography; LVOT, left ventricular outflow tract; TAVR, transcatheter aortic valve replacement.

• 

  Figure 2. Schematic drawing of the most likely mechanism of aortic injury. Preprocedural computed tomography (a) showed an enlarged and angulated aorta. Equipment traversed the aortic valve at an acute angle deflecting against the greater curvature. Trauma to the greater curvature by the valve delivery system likely initiated dissection (b).