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Aortic Valve Leaflet Avulsion After Transcatheter Aortic Valvuloplasty: A Case Series and Literature Review
Ammar Abusulb1, Robert Cubeddu1, Brian Solomon1
1Cardiovascular Medicine, Rooney Heart Institute-Naples Community Hospital, Naples, Florida, USA.
Background:
Aortic valve leaflet avulsion (AVLA) is recognized as a life-threatening adverse event that significantly affects patient hemodynamics, often leading to additional intervention.
Case Summary:
We report 2 cases from our institution of AVLA after transcatheter aortic valve replacement (TAVR). The patients had a highly mobile mass on the aortic annulus and the left ventricular outflow tract, respectively.
Discussion:
In both cases, a multidisciplinary team discussion resulted in the decision to monitor the patients for 48 hours for neurovascular changes while on therapeutic anticoagulation, and both patients were discharged on anticoagulants and low-dose aspirin. Their hospital courses were uneventful, and normally functional aortic valve bioprostheses were noted on follow-up.
Beyond The Guidelines:
The literature on AVLA after TAVR remains limited. The current treatment approaches for AVLA are primarily invasive, including surgical repair of the valve or snaring of avulsed structures.
Take-Home Message:
Conservative management may be appropriate in post-TAVR AVLA cases without ischemic or embolic manifestation.
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