2024 年 6 巻 1 号 p. 95-101
Objective: Worsening of mitral stenosis (MS) following transcatheter aortic valve implantation (TAVI) is rare, and the precise effect of percutaneous transluminal mitral commissurotomy (PTMC) on MS progression following TAVI remains unclear. We performed PTMC in patients with acute heart failure attributed to MS exacerbation following TAVI.
Case Presentation: An 88-year-old woman presenting with exertional dyspnea was admitted to our facility. The echocardiographic evaluation revealed severe aortic valve stenosis with an area of 0.5 cm² and a mean pressure gradient of 56 mmHg, in addition to a mitral valve mean pressure gradient of 5.4 mmHg. The patient was diagnosed with acute heart failure and severe aortic stenosis (AS) and underwent TAVI. Preoperative cardiac computed tomography revealed an aortic valve annular area of 380 mm² with moderate calcification and significant calcification of the mitral valve leaflet. A 23-mm Sapien3 valve was successfully implanted, thereby reducing the mean pressure gradient to 1 mmHg. However, the patient developed persistent respiratory distress the next day and exhibited increased pulmonary congestion upon chest radiography. While the AS improved, the mitral valve mean pressure gradient rose to 9.9 mmHg, and the patient experienced severe dyspnea at New York Heart Association class 3. PTMC was subsequently performed to manage severe MS, resulting in significant symptomatic relief.
Conclusion: This case report highlights a rare occurrence of heart failure exacerbation attributed to MS post-TAVI. The PTMC intervention effectively alleviated the patient's symptoms, thereby emphasizing the importance of prompt identification and management of MS exacerbation following TAVI.
