Transcatheter aortic valve implantation causing left ventricular perforation may be associated with an aberrant right subclavian artery: a case report.

Left ventricular perforation is an uncommon complication in transcatheter aortic valve implantation (TAVI). And a case of left ventricular perforation associated with an aberrant right subclavian artery (ARSA) has rarely been reported. An 86-year-old female attended our hospital with symptomatic severe aortic stenosis. Because of the patient's advanced age, and that she was a long-term steroid user, we treated her using TAVI. Although the presence of ARSA was noted, the aortic arch was a smooth arc on images of computed tomography (CT) along the axis of the aortic arch. A trans-femoral TAVI was performed. When the TAVI device passed through the aortic arch, the angle of the delivery system suddenly changed, and the guidewire was pushed in, which caused left ventricular perforation. We had to open the chest and perform a repair procedure. There was an enlarged space at the ARSA origin in three-dimensional (3D) CT, and this space may have caused the unexpected guidewire movement. The TAVI device may move in unexpected ways in presence of ARSA. It is necessary to carefully evaluate the access route using 3D CT as part of the preoperative evaluation to determine the safest treatment strategy. Supplementary Information: The online version contains supplementary material available at 10.1007/s12055-022-01429-9.

A Case of Right Ventricular Outflow Tract and Pulmonary Artery Reconstruction Using a Composite Graft in a Patient with Pulmonary Artery Intimal Sarcoma / 日本心臓血管外科学会雑誌

A 46-year-old man had a 3-week history of persistent cough. Chest radiography showed a mass in the left pulmonary hilum and contrast-enhanced computed tomography (CT) showed an infiltrative mass extending from the main pulmonary trunk to the left hilar region into the lung. He was referred to our hospital for multidisciplinary treatments. Echocardiography showed that the proximal side of the tumor reached the pulmonary valve. CT revealed that the heterogeneous low-density tumor extended from the main pulmonary trunk to the left and right pulmonary arteries, and the left side of the tumor extended beyond the left pulmonary hilum into the left lung. A mass shadow of 54 mm in length was also seen in the lower lobe of the left lung along the pulmonary artery. Although the left bronchus was compressed by the tumor, there was no obvious intratracheal invasion. Direct invasion to the descending thoracic aorta was suspected. He underwent the resection of the main pulmonary trunk and the left pulmonary artery along with the tumor concomitant with total left pneumonectomy. Reconstruction of the pulmonary artery and right ventricular outflow tract were performed as follows: The right ventricular outflow tract was reconstructed by using a semilunar shaped bovine pericardial patch. The pulmonary artery was replaced by using a composite graft with a Dacron tube graft and an aortic bio-prosthesis. He was discharged on the 22nd postoperative day. The pathological diagnosis of the tumor was pulmonary artery intimal sarcoma. Although there are various reconstruction methods for pulmonary artery intimal sarcoma depending on the affected site, reconstruction of the pulmonary artery and the right ventricular outflow tract by using a composite graft are considered to be a useful method.

A Case of Perigraft Seroma after Ascending Aorta Replacement That Was Cured by an Omental Pedicle Graft / 日本心臓血管外科学会雑誌

A 40-year-old man with a family history of Marfan syndrome was admitted to our hospital because of acute Stanford type A aortic dissection. He underwent a Bentall operation with an artificial vascular graft. Postoperative computed tomography revealed a low-density area around the graft in the ascending aorta and at the left subclavian artery cannulation site. He showed no symptoms and was discharged uneventfully. Five months after the operation, a pulsatile subdermal tumor appeared in the center of the median sternotomy. Computed tomography showed low- and high density fluid accumulation surrounding the ascending aortic graft, and this was connected with a subdermal tumor. We suspected collapse of the anastomotic site and performed an emergency operation. The fluid around the aortic graft was clear and diagnosed as perigraft seroma. To prevent recurrence, we filled the space around the aortic graft with an omental pedicle graft. After the operation, perigraft seroma did not recurr. In addition, with the disappearance of the seroma in the mediastinum, fluid accumulation at the left subclavian artery cannulation site also disappeared.