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

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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Case Report: Post transcatheter aortic valve replacement shock: Value of multimodal imaging

F1000Research ◽

10.12688/f1000research.9047.1 ◽

2016 ◽

Vol 5 ◽

pp. 2032 ◽

Cited By ~ 1

Author(s):

Sujatha P. Bhandary ◽

Andrew J. Otey ◽

Thomas J. Papadimos ◽

Juan A. Crestanello ◽

Barry S. George ◽

...

Keyword(s):

Case Report ◽

Coronary Artery ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Multimodal Imaging ◽

Left Main Coronary Artery ◽

Left Main ◽

Transcatheter Aortic Valve

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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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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Left Main Coronary Artery Obstruction by Dislodged Native-Valve Calculus after Transcatheter Aortic Valve Replacement

Texas Heart Institute Journal ◽

10.14503/thij-13-3410 ◽

2014 ◽

Vol 41 (4) ◽

pp. 414-417 ◽

Cited By ~ 6

Author(s):

Tahir Durmaz ◽

Huseyin Ayhan ◽

Telat Keles ◽

Abdullah Nabi Aslan ◽

Kemal Esref Erdogan ◽

...

Keyword(s):

Coronary Artery ◽

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Left Main Coronary Artery ◽

Left Main ◽

Transcatheter Aortic Valve ◽

Artery Obstruction

Transcatheter aortic valve replacement can be an effective, reliable treatment for severe aortic stenosis in surgically high-risk or ineligible patients. However, various sequelae like coronary artery obstruction can occur, not only in the long term, but also immediately after the procedure. We present the case of a 78-year-old woman whose left main coronary artery became obstructed with calculus 2 hours after the transfemoral implantation of an Edwards Sapien XT aortic valve. Despite percutaneous coronary intervention in that artery, the patient died. This case reminds us that early recognition of acute coronary obstruction and prompt intervention are crucial in patients with aortic stenosis who have undergone transcatheter aortic valve replacement.

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Delayed coronary obstruction of the left main artery after transcatheter aortic valve replacement

Terapevticheskii arkhiv ◽

10.26442/00403660.2020.04.000466 ◽

2020 ◽

Vol 92 (4) ◽

pp. 70-75

Author(s):

A. E. Komlev ◽

P. M. Lepilin ◽

E. V. Kurilina ◽

V. V. Romakina ◽

T. E. Imaev

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Clinical Symptoms ◽

Left Main ◽

Non Invasive ◽

Transcatheter Aortic Valve ◽

Aortic Valve Implantation ◽

Valve Implantation ◽

Coronary Obstruction

Coronary arteries obstruction associated with transcatheter aortic valve implantation (TAVI) may occur either during the procedure or after it. In the latter coronary obstruction can be further divided into early (7 days after procedure) or delayed one (7 days). Delayed coronary obstruction (DCO) is referred as a rare but devastating complication after TAVI and is associated with the extremely high mortality. This case demonstrates the objective difficulties of timely diagnostics of DCO. Since the results of non-invasive methods are indetermined in most cases, the authors conclude that even low-specific clinical symptoms must be interpreted as the definite rationale for the implementation of invasive diagnostic and treatment strategy.

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