Institute of Legal Medicine, University Hospital Bonn, Stiftsplatz 12, 53111, Bonn, Germany.
Forensic Sci Med Pathol. 2020 Jun;16(2):335-339. doi: 10.1007/s12024-020-00219-2. Epub 2020 Mar 14.
Transcatheter aortic valve implantation (TAVI) represents a catheter-based and minimally invasive replacement of the aortic valve. TAVI is considered to be a relatively safe procedure and has evolved to a standard procedure in inoperable and high-risk patients with aortic stenosis. We present a case of an octogenarian who died in hospital less than a day after an initially satisfactory TAVI. Cardiologists suspected a combination of cardiogenic and hemorrhagic shock as the cause of death. Autopsy showed rupture of an extensive aortic dissection, which had developed within 24 h after the procedure. The cause of death was eventually defined as internal bleeding due to a rapid two-stage vascular process. The manner of death was considered accidental because an iatrogenic vessel injury beyond the aortic arch was causative for the death. This unusual case highlights the potential for rare, but fatal, complications within the scope of cardiac catheterizations, such as TAVI. Additionally, our findings suggest that these complications need to be recognized in the diagnostic process and management of post-interventional complications.
经导管主动脉瓣植入术（TAVI）代表了一种基于导管的微创主动脉瓣置换术。TAVI 被认为是一种相对安全的手术，并且已经发展成为无法手术和高危主动脉瓣狭窄患者的标准手术。我们报告了一位 80 多岁的患者，在 TAVI 后不到一天就死于医院。心脏病专家怀疑心源性和出血性休克的组合是死亡的原因。尸检显示在手术后 24 小时内发展出广泛的主动脉夹层破裂。死亡原因最终被定义为由于快速的两阶段血管过程导致的内部出血。死亡方式被认为是意外的，因为升主动脉弓以外的医源性血管损伤是导致死亡的原因。这个不寻常的病例强调了在心脏导管检查范围内（如 TAVI）可能出现罕见但致命的并发症的可能性。此外，我们的发现表明，在介入后并发症的诊断过程和管理中需要识别这些并发症。
