Massive Aortic Regurgitation by Stuck Leaflet after Transcatheter Aortic Valve Implantation

Abstract

Purpose: Transcatheter aortic valve implantation (TAVI) is the mainstay of treatment for severe aortic stenosis and improves outcomes. However, complications of TAVI can lead to hemodynamic compromise. Aortic regurgitation (AR) is a frequent and mostly paravalvular complication; however, transvalvular leakage is rare because of stuck leaflets.

Case Presentation: A 90-year-old woman was admitted for acute decompensated heart failure; she was diagnosed with very severe aortic valve stenosis. The patient underwent transfemoral TAVI with a balloon-expandable valve. After valve deployment, moderate paravalvular leak was observed. Subsequently, she underwent post-dilatation; rapidly worsening hypotension was observed immediately. This condition necessitated cardiopulmonary resuscitation because of massive transvalvular AR caused by a stuck leaflet. After placing an emergency valve in valve, hemodynamic parameters improved rapidly.

Conclusion: This case describes massive AR caused by a stuck leaflet after post-dilatation during TAVI using a balloon-expandable valve.