Delayed Migration of a Transcatheter Aortic Valve Into the Left Ventricular Outflow Tract

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Late device migration is a rare complication following transcatheter aortic valve replacement (TAVR).
• Understanding the risk factors and presentation of late TAVR migration is essential for timely diagnosis and management.

Observation:

• A 60-year-old male with prior surgical aortic valve replacement and subsequent TAVR presented with chest discomfort and dyspnea.
• Transthoracic echocardiography revealed moderate prosthetic aortic regurgitation, severe prosthetic aortic valve stenosis, and evidence of valve migration.

Findings:

• The patient underwent a successful transcatheter aortic valve-in-valve (TAVI-in-TAVI) replacement to address the migrated valve.
• Late transcatheter heart valve migration, though uncommon, can occur due to retrograde forces overcoming endothelial attachment, potentially influenced by prior surgery, heart failure, and endothelial dysfunction.

Implications:

• Transcatheter heart valve migration represents a potentially lethal complication requiring prompt recognition.
• Patients with acute heart failure and a history of bioprosthetic valves necessitate urgent echocardiographic evaluation to rule out device migration.