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Pulsatile sterile abscess in the left breast following transapical transcatheter aortic valve implantation: a case report.

ABSTRACT: Over the last decade, transcatheter treatment of degenerative aortic valve stenosis has been established as an alternative to surgical aortic valve replacement. Late complications of transcatheter treatment of aortic stenosis (AS) are infrequent. We report an 87-year-old woman treated successfully with 23 mm Sapien 3 transapical transcatheter aortic valve implantation for severe AS. She presented 4 months later with a pulsatile mass in the left breast. After exclusion of other diagnoses, the mass was attributed to a sterile abscess communicating with the pericardial cavity due to post-operative chest infection and pleural effusion. Multimodality imaging helped to define the anatomy of the abscess and the mechanism of the pulsation. This is the first report of a pulsatile sterile abscess occurring as a complication of transapical aortic valve implantation. Multimodality imaging confirmed that the pulsation was due to extension of the abscess into the pericardial cavity, excluded direct communication with the left ventricle, and facilitated successful non-surgical management.

SUBMITTER: Khan HR

PROVIDER: S-EPMC6601158 | biostudies-literature | 2019 Jun

REPOSITORIES: biostudies-literature

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Pulsatile sterile abscess in the left breast following transapical transcatheter aortic valve implantation: a case report.

Khan Habib R HR Ansari Mohammad I MI Varcoe Richard W RW Henderson Robert A RA

European heart journal. Case reports 20190601 2

<h4>Background</h4>Over the last decade, transcatheter treatment of degenerative aortic valve stenosis has been established as an alternative to surgical aortic valve replacement. Late complications of transcatheter treatment of aortic stenosis (AS) are infrequent.<h4>Case summary</h4>We report an 87-year-old woman treated successfully with 23 mm Sapien 3 transapical transcatheter aortic valve implantation for severe AS. She presented 4 months later with a pulsatile mass in the left breast. Afte ...[more]

PMID: 31449589

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Project description:Off-pump transapical aortic valve implantation (TA-TAVI) through mini-thoracotomy was first performed in Vancouver, Canada in October 2005. The objective of this manuscript is to describe the Vancouver experience with 178 TA-TAVI cases in symptomatic severe aortic stenosis (AS) since 2005.Baseline characteristics and in-hospital outcomes were calculated for the overall cohort. To compare pre-procedure and post-procedure echocardiographic measurements, one way analysis of variance was utilized, followed by Tukey's HSD. In-hospital outcomes were compared between early and late cohorts using Z-test and chi-squared test as appropriate. Kaplan-Meier analysis was used to generate 3-year survival curves. The Log-rank test was used to compare survival between low-risk and high-risk groups, based on STS score.Between October 2005-March 2012, TA-TAVI was performed in 178 patients. Mean age was 80.5±8.6 years. Congestive heart failure and renal failure were more common in the late cohort, while previous myocardial infarction was more common in the early cohort (P<0.05). Eleven patients (6.2%) had significant intra-operative complications, including death (1.7%), conversion to CPB (3.9%), and valve embolization (1.1%). In-hospital survival was 87.9%. Mean length of hospital stay was 12.2±17.1 days. In-hospital incidence of stroke was 3.4%. Bleeding (20.2% vs. 4.7%) and vascular (14.6% vs. 3.5%) complications were more common in the early cohort. Echocardiography demonstrated a significant increase in aortic valve area and decrease in mean transvalvular gradient post-procedure. These improvements were maintained throughout the 3-year follow-up period. Overall survival was 72.1% at 6 months, 67.7% at 12 months, 55.5% at 24 months, and 47.3% at 36 months. Repeated Kaplan-Meier analysis for the 2 groups stratified by STS score, demonstrated improved survival in the low-risk group (Log-rank P=0.039).Among patients with symptomatic severe AS at high risk for conventional AVR, TA-TAVI is a reasonable therapeutic option with acceptable risk. Long-term survival appears to be superior in lower-risk patients.

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Pulsatile sterile abscess in the left breast following transapical transcatheter aortic valve implantation: a case report.

Publications

Pulsatile sterile abscess in the left breast following transapical transcatheter aortic valve implantation: a case report.

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