Aortic Dissection: An Unexpected Complication of Transcatheter Aortic Valve Implantation

A 53-year-old female with a medical history of multiple cardiovascular risk factors, alcoholic chronic hepatic disease (Child-Pugh B) with thrombocytopenia, and severe calcified aortic stenosis was admitted for an elective transcatheter aortic valve implantation (TAVI). After the procedure, the patient was hypotensive and unresponsive to fluid challenge, and there was a significant difference in blood pressure between the two arms. The echocardiogram confirmed the normal position and function of the prosthetic valve but was suggestive of aortic dissection. A thoracic angiotomography was urgently done and revealed a flap of the intima layer of the aorta at the aortic arch level, with a false lumen beginning proximal to the left subclavian artery but without extension to the ascending or descending aorta. A multidisciplinary team opted for conservative management of the aortic dissection, with medical treatment only. The patient was discharged later and remains clinically stable at a one-year follow-up.