ST-Segment Elevation Myocardial Infarction Caused by Embolized Transcatheter Aortic Valve in Ascending Aorta
Zvonimir Ostojic1, Hrvoje Jurin1, Josko Bulum1,2
1Department of Cardiovascular Diseases, University Hospital Center Zagreb, Zagreb, Croatia.
Insights
Embolized transcatheter aortic valve replacement (TAVR) valves can cause heart ischemia by blocking blood flow. Diagnosis and treatment involve aortography and aortic stent implantation to restore normal blood flow.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Device Technology
Background:
- Transcatheter aortic valve replacement (TAVR) is a common procedure for aortic stenosis.
- Valve embolization is a rare but serious complication of TAVR.
- Myocardial ischemia can occur due to complications during TAVR procedures.
Observation:
- Embolized TAVR valves can obstruct diastolic retrograde blood flow, leading to myocardial ischemia.
- Aortography with catheter positioning above the embolized valve and wire-induced leaflet opening can diagnose this ischemia.
- Electrocardiogram monitoring is crucial during diagnostic procedures.
Findings:
- Aortic stent implantation effectively resolves ischemia by enabling backflow.
- The described mechanism of ischemia is a critical consideration in TAVR complications.
- Simple diagnostic and treatment techniques exist for this specific complication.
Implications:
- Recognizing valve embolization as a cause of ischemia is vital for patient management.
- Prompt diagnosis and intervention can prevent adverse cardiac events.
- This approach highlights the importance of procedural vigilance and adaptability in TAVR.
Objective:
Embolized valves during transcatheter aortic valve replacement can cause myocardial ischemia by obstructing diastolic retrograde blood flow.
Key Steps:
To prove the described mechanism of ischemia, we performed aortography with catheter above the embolized valve and placed a stiff wire through the embolized valve, causing leaflet opening while monitoring electrocardiogram. As a treatment method, an aortic stent was implanted from the embolized valve into the aortic arch, enabling backflow and resolving the ischemia.
Potential Pitfalls:
Overlooking the described cause of ischemia is the biggest pitfall because it can be diagnosed and treated using simple techniques.
Take-Home Messages:
Embolized transcatheter aortic valve replacement valve can cause myocardial ischemia by blocking the diastolic backflow of blood. Aortography and opening of the embolized valve leaflets with wire can be used for diagnosis, and aortic stent implantation in the embolized valve can be used as a treatment modality.
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