PMC9843675_01
Echocardiographic assessment. (A) Echocardiographic showed left ventricular contractility, (B) aortic valve at axial view, (C) echocardiography continuous-wave Doppler across the aortic valve, and (D) echocardiographic parameters.
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Echocardiography showed suggested classical low-flow low-gradient severe AS (Figure 1).
Evaluation of the aortic valve and access route with computed tomography. (A-C) The aortic valve at axial view. (D) The aorta in three-dimensional view. (E) The ascending aorta at axial view. Ascending aortic dilatation of 57 x 58 mm was observed. (F) Evaluation of the aortic valve with computed tomography.
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We evaluated the aortic valve and access route with contrast-enhanced CT (Figure 2). We found a remarkable ascending aorta dilatation (57 x 58 mm) (Figure 2).
Valve delivery and implantation and aortic evaluation with transoesophageal echocardiography during transcatheter aortic valve implantation. (A) The prosthetic valve was delivered carefully. (B) The prosthetic valve was implanted at pressure of nominal -2 cc. (C and D) There were no injuries to the ascending and descending aorta.
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The prosthetic valve was implanted with the implantation pressure at nominal -2 cc (Figure 3). Transoesophageal echocardiography (TEE) was performed to carefully check the ascending and descending aorta for injuries, but there were no abnormal findings (Figure 3).
Computed tomography on the second day after transcatheter aortic valve implantation. (A-C) Aortic dissection was observed in the ascending aorta. (D) The entry of aortic dissection. (E) Left internal carotid artery occlusion.
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On the second day after the TAVI, she suddenly developed a loss of consciousness and the CT showed ascending AD (Figure 4).
Macroscopic findings and microscopic findings at autopsy (Elastica Van Gieson stain). (A and B) There was a dissection entry 5 cm distal to the prosthetic valve position. (C) Ascending aorta. (D) Control aorta. The elastic laminar was thinning in the ascending aorta compared with the control aorta. (E and F) The arrow indicated fragmentation to the elastic laminar.
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On autopsy, the macroscopic finding showed a sharp dissection entry 5 cm distal to the prosthetic valve level (Figure 5). Microscopic examination showed that the elastic laminar (EL) of the ascending aorta was thin compared with the control vessel and fragmentation of EL was observed (Figure 5).