Novel Percutaneous Apical Exclusion of a Left Ventricular Pseudoaneurysm After Complicated Transapical Transcatheter Aortic Valve Replacement

Publication Date


Journal Title

JACC Cardiovasc Interv


A 78-year-old woman with a history of coronary artery bypass grafting underwent transapical transcatheter aortic valve replacement with a Sapien XT (Edwards, Irvine, California) prosthesis that was complicated by an apical left ventricular pseudoaneurysm (LVPA). Unsuccessful attempts at closure included percutaneous, retrograde transaortic placement of a 12-mm Amplatzer Ventricular Septal Defect occluder (St. Jude Medical, Minneapolis, Minnesota) and surgical CorMatrix (CorMatrix, Roswell, Georgia) patch repair on cardiopulmonary bypass, both with residual expanding and/or recurrent LVPA. A novel transcatheter approach was performed to exclude the left ventricular apex and flow into the LVPA. Using computed tomography–fluoroscopy fusion imaging (HeartNavigator, Philips, Best, the Netherlands), percutaneous transapical access was performed adjacent to the true apical site of the LVPA. The 26-mm Amplatzer septal and 35-mm Amplatzer cribriform occluders were positioned and deployed with the distal disks overlapping, excluding the apical cavity, and the proximal disks positioned on the epicardial surface. Residual flow was noted through the polyester fabric of the devices, and an additional percutaneous transapical access through the LVPA exit site was performed with placement of a 4-F sheath. Three 0.052-inch 10 × 15-mm coils (Cook Medical, Bloomington, Indiana) soaked in thrombin were placed within the excluded apical segment. Echocardiography revealed no further flow into the LVPA, with increased echogenicity of the sac suggesting thrombosis. Computed tomography performed prior to discharge confirmed total occlusion of the LVPA with complete apical exclusion (Figure 1).

Volume Number


Issue Number




Document Type



Faculty; Northwell Researcher


School of Medicine; Northwell Health

Primary Department

Cardiovascular and Thoracic Surgery

Additional Departments

Cardiology; Pediatrics