Balloon Rupture during Pre-Dilation for Transcatheter Aortic Valve Replacement in Patients with a Bicuspid Aortic Valve: Classification, Treatment Strategies, and Prevention

Balloon rupture during transcatheter aortic valve replacement (TAVR) is a rare but serious complication. Here, we present two cases of balloon rupture in patients with severe aortic stenosis and type 0 bicuspid aortic valves. Three-dimensional models based on pre-procedure cardiac CT angiography were used to investigate these cases post hoc. The models revealed asymmetrical distribution of calcifications with sharply spiked features in the bicuspid aortic valves. The narrow calcified orifices resulted in uneven force distribution on the expanded balloon, thus leading to balloon rupture. We additionally review the classification and causes of balloon rupture, summarize methods for avoiding complications, and describe treatment options. Accurate pre-procedural anatomy evaluation and computer modeling are crucial for planning and managing TAVR procedures. Further investigation through computer simulation is necessary to determine the appropriate balloon size and inflation locations, to provide a reference for pre-procedural preparation.