William C. Roberts, MD, Robert C. Stoler, MD, Paul A

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Presentation transcript:

Necropsy Findings Early After Transcatheter Aortic Valve Implantation for Aortic Stenosis William C. Roberts, MD, Robert C. Stoler, MD, Paul A. Grayburn, MD, Robert F. Hebeler, MD, Jong M. Ko, BA, David L. Brown, MD, William T. Brinkman, MD, Michael J. Mack, MD, Joseph M. Guileyardo, MD American Journal of Cardiology Volume 111, Issue 3, Pages 448-452 (February 2013) DOI: 10.1016/j.amjcard.2012.09.038 Copyright © 2013 Elsevier Inc. Terms and Conditions

Figure 1 Case 2. Four-chamber echocardiogram obtained during cardiac arrest. A large pericardial effusion (PE) is present. The arrow points to a perforation in the subepicardial adipose tissue above the right ventricular apex. The right ventricular cavity (RV) is collapsed, and the left ventricular cavity (LV) is of normal size. American Journal of Cardiology 2013 111, 448-452DOI: (10.1016/j.amjcard.2012.09.038) Copyright © 2013 Elsevier Inc. Terms and Conditions

Figure 2 Case 1. Aortic arch and descending thoracic aorta showing focal but fairly heavy calcific deposits. American Journal of Cardiology 2013 111, 448-452DOI: (10.1016/j.amjcard.2012.09.038) Copyright © 2013 Elsevier Inc. Terms and Conditions

Figure 3 Case 1. (A) Photograph exposing the right and left atria, aorta with the bioprosthesis, and pulmonary trunk. (B) View of both ventricles and atrioventricular valves. The left ventricular cavity is of normal size. The quantity of subepicardial adipose tissue is large. Calcium is present in the mitral annular region and in the left anterior descending coronary artery. The right ventricular cavity is dilated, and its wall is thickened. American Journal of Cardiology 2013 111, 448-452DOI: (10.1016/j.amjcard.2012.09.038) Copyright © 2013 Elsevier Inc. Terms and Conditions

Figure 4 Case 1. Multiple views of the aortic valve area with the bioprosthesis in place (A to C) and after removal of the bioprosthesis. The 3 calcified aortic valve cusps are compressed against the aortic wall, providing a large central bioprosthetic orifice (E). The 2 radiographs of the aortic valve area (C,D) show heavy calcific deposits in each native cusps. American Journal of Cardiology 2013 111, 448-452DOI: (10.1016/j.amjcard.2012.09.038) Copyright © 2013 Elsevier Inc. Terms and Conditions

Figure 5 Case 2. Aorta. (A) Radiograph of arch and descending thoracic aorta showing focal but extensive calcific deposits. (B) Radiograph of abdominal aorta and common iliac arteries showing massive near diffuse calcific deposits. (C) Photograph of the aortic arch and descending thoracic aorta showing adventitial blood, the source of which was not determined. American Journal of Cardiology 2013 111, 448-452DOI: (10.1016/j.amjcard.2012.09.038) Copyright © 2013 Elsevier Inc. Terms and Conditions

Figure 6 Case 2. (A) Radiograph of the base of the heart at autopsy showing the metallic cage of the bioprosthesis and calcific deposits and stent in the right coronary artery and focal calcific deposits in the left main, left anterior descending, and left circumflex coronary arteries and in the mitral annular area. (B) Photograph of the base of the heart showing a normal-sized left ventricular cavity and a dilated right ventricular cavity. The anterior mitral leaflet is thickened, probably due to the small space within the left ventricular cavity. American Journal of Cardiology 2013 111, 448-452DOI: (10.1016/j.amjcard.2012.09.038) Copyright © 2013 Elsevier Inc. Terms and Conditions

Figure 7 Case 2. Aortic valve area. (A) View from above with the bioprosthesis in place and the 3 calcified cusps pushed laterally. The ostium of the right coronary artery is directly behind the right aortic valve cusp. The ostium of the left main coronary artery is just cephalad to the free margin of the left aortic valve cusp. (B) View more caudal than the one in (A). There is plenty of room for the bioprosthetic orifice. (C) Radiograph of the bioprosthesis and calcified aortic valve cusps after removal from the heart. (D) View of the bioprosthetic cusps from the left ventricular aspect. American Journal of Cardiology 2013 111, 448-452DOI: (10.1016/j.amjcard.2012.09.038) Copyright © 2013 Elsevier Inc. Terms and Conditions

Figure 8 Case 2. (A,B) Close-up views of the metallic struts of the bioprosthesis compressing the calcified native aortic valve cusps against the aortic wall. American Journal of Cardiology 2013 111, 448-452DOI: (10.1016/j.amjcard.2012.09.038) Copyright © 2013 Elsevier Inc. Terms and Conditions