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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
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Post trans-catheter aortic valve replacement shock: Back to the basics.
Ali Z Zgheib1, Dounia Z Iskandarani1, Jennifer Jdaidani1
1American University of Beirut Medical Center, Division of Cardiology, Beirut, Lebanon.
Journal of Cardiology Cases
|August 4, 2022
Summary
Transcatheter aortic valve replacement (TAVR) can lead to complications like severe paravalvular leak (PVL) and left ventricular outflow tract (LVOT) obstruction. Early, aggressive workup with transesophageal echocardiography is crucial for unstable patients post-TAVR.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Severe aortic stenosis (AS) is treated with Transcatheter Aortic Valve Replacement (TAVR).
- Hemodynamic compromise post-TAVR can arise from various immediate complications.
- Significant paravalvular leak (PVL) is less common with newer TAVR devices.
Observation:
- An 82-year-old female with severe AS underwent TAVR.
- The patient experienced hemodynamic compromise due to severe PVL and left ventricular outflow tract (LVOT) obstruction, underestimated by transthoracic echocardiography.
- PVL was treated with a vascular plug, and LVOT obstruction with alcohol septal ablation.
Findings:
- Severe PVL and dynamic LVOT obstruction can cause unexplained hypotension post-TAVR.
- Transesophageal echocardiography is vital for diagnosing these complications when transthoracic echocardiography is insufficient.
- Early and aggressive diagnostic workup is essential for unstable patients following TAVR.
Implications:
- Highlights the importance of advanced imaging like TEE in managing complex TAVR cases.
- Emphasizes the need for prompt intervention for PVL and LVOT obstruction to ensure patient stability.
- Underscores the critical role of a comprehensive diagnostic approach in post-TAVR patient care.
Keywords:
Aortic valve diseaseAortic valve disease percutaneous interventionParavalvular leakShock cardiogenicStructural heart disease interventionTranscatheter valve implantationMore Related Videos
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