Valve-in-Valve Implantation for Aortic Annular Rupture Complicating Transcatheter Aortic Valve Replacement (TAVR)

An 83-year-old woman with multiple comorbidities and severe aortic stenosis presented with recurrent pulmonary edema. In light of her high surgical risk, a percutaneous strategy for her aortic stenosis was decided. Transcatheter aortic valve replacement using a balloon-expandable Edwards Sapien XT valve was performed under rapid ventricular pacing. Soon after valve deployment, the patient went into hemodynamic collapse due to annular root rupture with pericardial tamponade, necessitating urgent pericardial decompression. Using a valve-in-valve technique, with the deployment of a second Edward Sapien XT valve inside the first valve, the annular root rupture was successfully sealed leading to hemodynamic recovery.