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Unusual cause of myocardial infarction following transcatheter aortic valve replacement
1Department of Cardiovascular Disease East Carolina University Greenville North Carolina USA.
Insights
Transcatheter aortic valve replacement (TAVR) can rarely cause left coronary artery embolism from aortic valve leaflet tissue. Prompt diagnosis and intervention are crucial for successful patient outcomes in this serious complication.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Transcatheter aortic valve replacement (TAVR) is a common procedure for aortic stenosis.
- Complications, though rare, require prompt recognition and management.
- Left coronary artery embolism from aortic valve leaflet tissue is a seldom-seen but critical complication.
Key Clinical Message:
Left coronary artery embolism from aortic valve leaflet tissue mass is a rare but potentially life-threatening complication following transcatheter aortic valve replacement. It is important for interventional cardiologists to be aware of this rare complication for rapid identification and prompt treatment which is the key to a successful outcome.
Abstract:
An 81-year-old female presented for elective transcatheter aortic valve replacement (TAVR) for severe low-flow low-gradient aortic stenosis. Immediately post-procedure, she developed unexplained, persistent hypotension. There was no bleeding. There was no aortic injury. Activated clotting time was in therapeutic range. Coronary angiography revealed hazy filling defects in left anterior descending and left circumflex. Intravascular ultrasound showed heterogeneous, hypoechoic mass with mild calcification consistent with embolized valve leaflet tissue. This was treated with emergent percutaneous coronary intervention with excellent results. Left coronary artery embolism from aortic valve leaflet tissue is a rare, but potentially life-threatening complication following TAVR. Prompt recognition is key to a successful outcome.
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