A case of aortic valve laceration after balloon aortic valvuloplasty with morphological features.

ABSTRACT

A 71-year-old man suffered from congestive heart failure due to severe aortic stenosis. We performed balloon aortic valvuloplasty (BAV) as a bridge to transcatheter aortic valve replacement using transesophageal echocardiogram (TEE) by the retrograde approach. Balloon dilatation was carefully performed using an 18 mm balloon. After balloon dilation, TEE showed right coronary cusp (RCC) laceration and severe aortic regurgitation. We discontinued the procedure despite the incomplete result. Aortic valve laceration is a rare complication considered to be mainly caused by the use of large balloon or by balloon slipping. In the present case, TEE showed that the commissure of RCC fused strongly with both the other cusps by thick calcification, and the center of RCC had a spotty low echoic area with soft tissue. The force of the balloon dilatation concentrated to soft tissue area and lacerated the center of RCC. We verified the finding in the operative specimen. When performing BAV, we should pay attention to the morphology of the aortic valve using TEE to avoid aortic valve laceration as a fatal complication. <Learning objective: Aortic valve laceration is a rare complication. The main reasons of laceration are considered to be a large size balloon or balloon slipping. The morphology of the aortic valve may cause the laceration as observed in the present case. It is important to pay attention to the morphology of the aortic valve by preoperative transesophageal echocardiogram.>.