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Transcatheter aortic valve replacement for pure native aortic regurgitation
Christina Gkotsoulia1, Sarah Mauler-Wittwer2, Dionysios Adamopoulos2
1Cardiology, HUG, Geneva, Switzerland christina.gkotsoulia@hug.ch.
BMJ Case Reports
|October 6, 2025
Summary
This case study details a severe aortic regurgitation (AR) diagnosis missed due to tachycardia, successfully treated with transcatheter aortic valve replacement (TAVR). TAVR shows promise for native pure AR (NPAR) despite challenges.
Area of Science:
- Cardiology
- Oncology
Background:
- Trousseau's syndrome, associated with malignancy, can present with thromboembolic events.
- Severe aortic regurgitation (AR) can be challenging to diagnose, especially with confounding factors like tachycardia.
Purpose of the Study:
- To report a case of ovarian cancer with Trousseau's syndrome presenting as stroke due to missed severe AR.
- To highlight the diagnostic challenges of AR and the potential utility of transcatheter aortic valve replacement (TAVR) in native pure AR (NPAR).
Main Methods:
- Case report of a female patient in her 60s with advanced ovarian cancer.
- Diagnostic workup included transthoracic echocardiography and assessment of femoral flow.
- Treatment involved transcatheter aortic valve replacement (TAVR) using the Acurate NEO 2 valve.
Main Results:
- Severe aortic regurgitation secondary to a prolapsed aortic valve leaflet was diagnosed.
- Initial echocardiography missed the diagnosis due to patient tachycardia.
- TAVR led to initial symptom improvement, though the patient later developed prosthetic valve thrombosis and succumbed to oncological complications.
Conclusions:
- Accurate diagnosis of AR is crucial, even in complex cases with malignancy and other comorbidities.
- Transcatheter aortic valve replacement (TAVR) is a viable option for selected patients with native pure AR (NPAR), offering promising outcomes with newer generation valves.
- Off-label use of transcatheter heart valves (THVs) for NPAR may be considered, with anticipated increased use of on-label devices as availability improves.
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