Acute left main stem coronary occlusion following transcatheter aortic valve replacement in a patient without recognized coronary obstruction risk factors: a case report

Complications resulting from the delayed clinical presentation of a left main coronary artery obstruction can be catastrophic. This case report presents a 73-year-old woman with severe aortic stenosis who underwent transcatheter aortic valve replacement with a core valve who, approximately 20 minutes after heparin reversal with protamine, became hypotensive and was unresponsive to vasopressor and inotropic therapy. Transesophageal echocardiography demonstrated global hypokinesis, which was highly consistent with the occlusion of the left main coronary artery. Angiography confirmed this diagnosis and demonstrated that valve positioning had not changed compared to post-placement examination. Here we report the partial covering of the ostium of the left main coronary artery by a core valve skirt that converted into a total occlusion following the initiation of heparin reversal with protamine and the value of multimodal imaging in the management of this case.

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159-I * REPAIR OF LEFT MAIN CORONARY OCCLUSION AND ANNULAR DISRUPTION FOLLOWING TRANSCATHETER AORTIC VALVE REPLACEMENT

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivt372.159 ◽

2013 ◽

Vol 17 (suppl 2) ◽

pp. S108-S108

Author(s):

D. Watson ◽

S. Yakubov

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Coronary Occlusion ◽

Left Main ◽

Transcatheter Aortic Valve

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Calcium Resection to Relieve Left Main Coronary Obstruction in Transcatheter Aortic Valve Replacement

Journal of Cardiac Surgery ◽

10.1111/jocs.12752 ◽

2016 ◽

Vol 31 (5) ◽

pp. 315-317 ◽

Cited By ~ 2

Author(s):

Gilbert H. L. Tang ◽

Hasan Ahmad ◽

Martin Cohen ◽

Cenap Undemir ◽

Steven L. Lansman

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Left Main ◽

Transcatheter Aortic Valve ◽

Coronary Obstruction

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Delayed left main coronary obstruction following transfemoral inovare transcatheter aortic valve replacement: A challenging case

Journal of Cardiology Cases ◽

10.1016/j.jccase.2021.06.012 ◽

2021 ◽

Author(s):

Gabriel Kanhouche ◽

Felipe Reale Cividanes ◽

Roney Orismar Sampaio ◽

José Carlos Albuquerque da Silva ◽

Rodrigo Daghlawi Machado ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Left Main ◽

Transcatheter Aortic Valve ◽

Coronary Obstruction

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Delayed-Onset Left Main Coronary Artery Obstruction More than 24 Hours after Balloon-Expandable Transcatheter Aortic Valve Replacement

Texas Heart Institute Journal ◽

10.14503/thij-15-5475 ◽

2016 ◽

Vol 43 (5) ◽

pp. 441-445 ◽

Cited By ~ 1

Author(s):

Tsuyoshi Isawa ◽

Norio Tada ◽

Tatsushi Ootomo

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Left Main Coronary Artery ◽

Left Ventricular ◽

Left Main ◽

Transcatheter Aortic Valve ◽

Valve Implantation ◽

Coronary Obstruction

Coronary obstruction during or after transcatheter aortic valve replacement is a rare and catastrophic sequela that occurs most frequently just after valve implantation. Even rarer is the delayed clinical presentation, in some few patients, of coronary obstruction on the day after self-expandable valve implantation. Here we describe a case of balloon-expandable (not self-expandable) transcatheter aortic valve replacement, followed by partial obstruction of the left main coronary artery on the day after that procedure in a 93-year-old man, despite normal left ventricular contraction just after valve implantation. Visual evaluation of the echocardiogram for left ventricular wall motion was not sufficient, by itself, to achieve early diagnosis of the obstruction. We performed emergency percutaneous coronary intervention. Ninety days after the procedure, the patient was in New York Heart Association functional class I.

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