High Prosthetic Implantation and Thrombosis in Native Aortic Sinus of Valsalva after Transcatheter Aortic Valve Implantation

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Objective: Though high prosthesis implantation mitigates the risk of conduction disturbance after transcatheter aortic valve implantation (TAVI) using the self-expandable valve, we have to be aware of the increasing risk of delayed coronary obstruction particularly in patients with small anatomy.

Case Presentation: A 76-year-old female was admitted to the emergent room complaining chest pain at rest. Prior to this admission, she underwent TAVI with a self-expandable valve using the cusp overlap technique. Based on the finding of ST-segment elevation at inferior leads, we emergently performed coronary angiography and found severe stenosis at the ostium of right coronary artery. After percutaneous coronary intervention (PCI), intravascular ultrasound (IVUS) images detected thrombus within the stent located in the native sinus, which could not find during preprocedural IVUS. After the PCI, we added warfarin to single antiplatelet therapy as antithrombotic therapy to suppress the thrombus within the native sinus of Valsalva (SOV). After a year of this emergent PCI, she had no symptoms and no rehospitalization.

Conclusion: We experienced a case of delayed coronary obstruction due to a thrombus of the native SOV after TAVI using a self-expandable valve, confirmed by multi-imaging modalities.