Transapical aortic valve replacement complicated by periaortic hematoma

A 77-year-old woman with severe symptomatic aortic stenosis (aortic valve areaZ0.6 cm 2 and mean gradientZ 53 mmHg) was deemed inoperable for surgical aortic valve replacement due to a porcelain aorta, and was scheduled for transcatheter aortic valve replacement via an apical approach. A 23 mm valve was selected based on a computerized axial tomographic angiography derived area of 360 mm 2 ; valve oversizing was 15.4%. Baseline Figure 1 (A) Baseline transesophageal echocardiographic long-axis view of the aortic valve and ascending aorta. Note severe atherosclerotic plaque in the ascending aorta with protruding elements (arrow). (B) Similar view as 1A immediately following valve deployment. A larger posterior periaortic hematoma is now present (arrow). (C) Short-axis view of the proximal aorta demonstrating the extensive posterior periaortic hematoma (arrow). (D) Long-axis zoom view of the ascending aorta and periaortic hematoma (arrow).