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Obstruction of 2 Coronary Arteries from Different Causes Immediately after Transapical Transcatheter Aortic Valve

Umihiko Kaneko, Ryuji Koshima, Hirosato Doi

    Texas Heart Institute Journal
    |March 10, 2020
    PubMed

    Insights

    Coronary obstruction is a rare but fatal complication after transcatheter aortic valve replacement. This case details two coronary arteries obstructed post-procedure, highlighting management strategies.

    Area of Science:

    • Cardiology
    • Interventional Cardiology
    • Cardiac Surgery

    Background:

    • Severe aortic stenosis necessitates intervention, with transcatheter aortic valve replacement (TAVR) offering a less invasive option.
    • Coronary obstruction is a rare, potentially fatal complication following TAVR, with limited data on multiple vessel involvement.
    • Transapical TAVR involves accessing the aortic valve through the apex of the heart, carrying specific procedural risks.

    Observation:

    • An 81-year-old woman developed sudden cardiogenic shock immediately after a transapical TAVR procedure.
    • The obstruction involved both the left main coronary artery ostium and the distal left anterior descending coronary artery.
    • Left main obstruction was attributed to direct compression by calcified aortic material and the TAVR valve frame.

    Findings:

    • The distal left anterior descending artery obstruction was caused by myocardial tightening and external compression from apical closure sutures.
    • Successful revascularization was achieved via coronary stent placement for the left main obstruction.
    • Suture removal effectively addressed the left anterior descending artery obstruction.

    Implications:

    • This case underscores the risk of dual coronary artery obstruction after transapical TAVR.
    • It highlights the importance of recognizing and managing this rare complication promptly.
    • The findings suggest specific mechanisms and management strategies for coronary obstructions in the context of transapical TAVR.

    Keywords:
    Aged, 80 and overaortic valve stenosis/complicationscoronary occlusion/diagnosis/therapyheart valve prosthesis implantation/adverse effectspercutaneous coronary interventionsuture techniques/adverse effectstranscatheter aortic valve replacement/adverse effects/methodstreatment outcome

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