2025 年 7 巻 1 号 p. 85-87
Objective: Coronary artery occlusion can occur after transcatheter aortic valve implantation (TAVI), even in patients without identifiable risk factors. Careful assessment using transesophageal echocardiography (TEE) is beneficial for identifying catastrophic complications.
Case Presentation: An 85-year-old man with a history of hypertension and angina pectoris on exertion was referred to our hospital. Coronary computed tomography (CT) demonstrated the absence of severe coronary artery lesions, while echocardiography revealed severe aortic stenosis. Considering the patient’s age, TAVI was selected as the best treatment option after an evaluation by cardiologists and surgeons. Preoperative CT reported that the right and left coronary heights were 16.6 and 13.6 mm, respectively. Therefore, the risk of coronary artery occlusion was considered low. Routine TEE after implantation of a balloon-expandable prosthetic valve revealed accelerated blood flow in the left main trunk (LMT). Intravascular ultrasound confirmed a stenotic lesion equivalent with a minimum lumen area of 4.8 mm2 in the LMT orifice. Angioplasty was promptly performed with the deployment of a drug-eluting stent. The patient was discharged on day 16 without further complications.
Conclusion: We encountered a case in which TEE revealed LMT stenosis after TAVI in a patient at low risk for coronary artery occlusion. Early detection of accelerated blood flow using intraoperative TEE may have prevented subsequent coronary artery occlusion.
