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Transcatheter Aortic Valve Implantation (core valve) prosthesis complicated by mitral stenosis

Mohammed Balghith1, Ahmad Omran, Ahmad Saileek

  • 1King Saud Bin Abdulaziz University for Health Sciences, KACC, National Guard, Riyadh 11426, Saudi Arabia.

Journal of the Saudi Heart Association
|August 21, 2013
PubMed

Insights

Transcatheter aortic valve implantation (TAVI) successfully treated severe aortic stenosis. However, the prosthesis impinged the mitral valve, causing mild mitral stenosis. Transesophageal echocardiography (TEE) is crucial for diagnosing this complication.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Severe aortic stenosis (AS) poses significant risks, necessitating effective treatment strategies.
  • Transcatheter aortic valve implantation (TAVI) is a viable option for AS patients, particularly the elderly.
  • Complications following TAVI, such as prosthesis-patient mismatch or structural issues, require careful monitoring.

Purpose of the Study:

  • To report a case of mild mitral stenosis secondary to TAVI prosthesis impingement.
  • To highlight the diagnostic utility of transesophageal echocardiography (TEE) in identifying this specific complication.

Main Methods:

  • A 90-year-old male with severe AS underwent TAVI with a 29 mm Core valve prosthesis.
  • Post-procedure transthoracic echocardiogram (TTE) and transesophageal echocardiogram (TEE) were performed for evaluation.
  • Clinical assessment included chest pain, shortness of breath, and lower limb swelling.

Main Results:

  • Successful deployment of the TAVI prosthesis.
  • Post-TAVI TTE revealed normal ejection fraction but indicated mild mitral stenosis (MV area = 2.04 cm², mean gradient = 6 mmHg).
  • TEE confirmed impingement of the anterior mitral valve leaflet by the prosthesis inflow, causing the MS.

Conclusions:

  • Prosthesis impingement on the mitral valve is a potential complication of TAVI.
  • TEE is an essential diagnostic tool for detecting prosthesis-related mitral stenosis after TAVI.
  • Careful pre- and post-procedural echocardiographic assessment is vital in TAVI patients.

Keywords:
Aortic stenosisMitral stenosisTranscatheter aortic valve implantation

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