Structural Heart 6 (2022) 100018

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Structural Heartjournal homepage: www.structuralheartjournal.org

Images in Structural Heart Disease

Superior Mesenteric Artery Embolism Complicating Transcatheter
Aortic Valve Replacement
Takehiro Yamashita, MD, PhD a, * , Naoki Iwakiri, MD a, Eigo Kurebayashi, MD a,Hitoshi Kimura, MD b, Masaki Murata, MD cabc

Department of Cardiology, Cardiovascular Center, Hokkaido Ohno Memorial Hospital, Sapporo, Hokkaido, Japan
Department of Surgery, Hokkaido Ohno Memorial Hospital, Sapporo, Hokkaido, Japan
Department of Pathology, Hokkaido Ohno Memorial Hospital, Sapporo, Hokkaido, JapanA R T I C L E I N F O
Article history:
Submitted 12 May 2021
Revised 11 August 2021
Accepted 3 November 2021
Available online 8 April 2022
Keywords:
Bowel ischemia
Complication
Intravascular aspiration
Superior mesenteric artery embolism
Transcatheter aortic valve replacement

An 83-year-old male was scheduled for transcatheter aortic valve
replacement for severe aortic valve stenosis. Although preproceduralcomputed tomography demonstrated atherosclerotic plaques protruding
into the descending aortic lumen (Figure 1), we concluded a transfemoral
approach was feasible. However, while advancing the valve system throughthe descending aorta, the echocardiographer detected a fragment detachedfrom the protruding plaque on transesophageal echocardiography (notrecorded). A 26-mm Sapien 3 (Edwards Lifesciences, Irvine, California) was
successfully implanted (Figure 2) while transesophageal echocardiographydelineated a contrasting conﬁguration of the plaque (Figure 3a and b,Supplemental Video 1). Emergency superior mesenteric artery angiographydemonstrated an embolic partial obstruction (Figure 4a), and anFigure 1. Preprocedural computed tomography showing protruding plaques into the descending aortic lumen.

intravascular aspiration procedure, using an Export Advance catheter(Medtronic, Minneapolis, Minnesota), restored blood ﬂow to the ileocolicterritory (Figure 4b). His post-transcatheter aortic valve replacement course* Address correspondence to: Takehiro Yamashita, MD, PhD, Cardiology, Cardiovascular Center, Hokkaido Ohno Memorial Hospital, 2-1-16-1, Miyanosawa,Nishiku, Sapporo, Hokkaido 063-0052, Japan
E-mail address: t_yamashita@cvc-ohno.or.jp (T. Yamashita).

https://doi.org/10.1016/j.shj.2022.100018
2474-8706/© 2022 The Authors. Published by Elsevier Inc. on behalf of Cardiovascular Research Foundation. This is an open access article under the CC BY-NC-ND
license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

T. Yamashita et al.

Structural Heart 6 (2022) 100018

Figure 2. Aortography after Sapien 3 implantation.

Figure 3. Transesophageal echocardiography (TEE) showing a guidewire (arrow) with the protruding plaque (arrowhead) before (a) and after (b) device
advancement.

Figure 4. Superior mesenteric artery angiography showing embolic partial obstruction of the mid portion before the aspiration procedure (a) and restoration of blood
ﬂow to ileocolic territory after the procedure (b). Arrow heads indicate partially improved blood ﬂow to iliocolic territory.
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Structural Heart 6 (2022) 100018

Figure 5. Pathology of the aspirate showing cholesterol clefts (green arrows), foamy macrophages (blue arrows), and calciﬁcation (yellow arrow) in low (a) and high(b) magniﬁcations.

was uneventful with no signs of bowel ischemia. Pathology showed theretrieved material was a fragment of atherosclerotic plaque with typicalcholesterol clefts and foamy macrophages (Figure 5a and b).

Funding

ORCIDsDisclosure statement

Takehiro Yamashita

The authors have no funding to report.

The authors report no conﬂict of interest.

https://orcid.org/0000-0001-5918-4308

Consent Statement

Supplementary Material

Patient consent for publication of this report and accompanying images was obtained by the authors.

Supplemental data for this article can be accessed on the publisher’s
website.

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