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Don't Trust the Imaging: Necrotic Bowel Following Transcatheter Aortic Valve Replacement Through Aortic Stent Graft

Arsalan Abu-Much1,2, Israel M Barbash1,2, Victor Guetta1,2

  • 1Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel.

JACC. Case Reports
|July 28, 2021
PubMed

Insights

Mesenteric ischemia, a rare complication of transcatheter aortic valve replacement (TAVR), can be lethal. This case highlights a patient with post-TAVR abdominal pain and necrotic bowel despite negative imaging, emphasizing diagnostic challenges.

Area of Science:

  • Cardiology
  • Gastroenterology
  • Vascular Surgery

Background:

  • Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure for aortic stenosis.
  • Mesenteric ischemia is a serious but uncommon complication following cardiovascular interventions.
  • Early recognition and management are crucial for improving patient outcomes.

Observation:

  • An 80-year-old male presented with acute abdominal pain hours after undergoing TAVR.
  • Serial abdominal and pelvic imaging, including CT angiography, did not reveal evidence of vascular obstruction.
  • Exploratory laparoscopy was required to diagnose extensive small bowel necrosis.

Findings:

  • The case demonstrates a diagnostic dilemma where imaging findings were discordant with clinical presentation.
  • Mesenteric ischemia can occur post-TAVR even without clear vascular obstruction on imaging.
  • Laparoscopy remains a critical tool for diagnosing intra-abdominal catastrophes.

Implications:

  • Clinicians should maintain a high index of suspicion for mesenteric ischemia in patients with abdominal pain post-TAVR.
  • Multidisciplinary collaboration between cardiology, radiology, and surgery is essential for timely diagnosis and treatment.
  • This case underscores the importance of considering rare but life-threatening complications in the post-procedural care of TAVR patients.
Keywords:
CT, computed tomographyCTA, computed tomography angiographyEVAR, endovascular aortic repairNOMI, nonocclusive mesenteric ischemiaSMA, superior mesenteric arteryTAVR, transcatheter aortic valve replacementaortic valvecomplicationnecrosisstenosisthrombosisthrombusvalve replacement

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