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Updated: Feb 22, 2026
06:04
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
641
Delayed prosthesis malposition after transcatheter aortic valve implantation causing coronaries obstruction
Francesco Nappi1, Cristiano Spadaccio2,3, Jean-Louis Sablayrolles4
1Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis (CCN), Saint-Denis, Paris, France.
Summary
Delayed CoreValve malposition caused coronary obstruction. Cardiac-gated computed tomography identified fibrosis/calcification on the misplaced valve as the cause, aiding diagnosis and decision-making.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Transcatheter aortic valve replacement (TAVR) is a common procedure for aortic stenosis.
- Device malposition can lead to complications.
- Coronary ostial obstruction is a rare but serious complication after TAVR.
Observation:
- A case of delayed CoreValve malposition nine months post-implant.
- Patient presented with acute coronary syndrome due to ostial stenosis of left main and right coronary arteries.
- Paravalvular leakage was noted from the bioprosthesis.
Findings:
- Gated computed tomography (CT) revealed valve malposition with cusps 14 mm above the right coronary ostium.
- Fibrous and calcific agglomerations on a misplaced cusp caused tight left ostial stenosis.
- CT identified valve-related fibrosis/calcification as the trigger for coronary obstruction.
Implications:
- Cardiac-gated CT is crucial for diagnosing TAVR complications.
- This case highlights an unusual phenomenon of fibrosis/calcification causing coronary obstruction.
- Promoting cardiac-gated CT can improve diagnosis and clinical decision-making in TAVR patients.
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