Post-Transcatheter Aortic Valve Replacement Acute Severe Mitral Regurgitation: A Case Report

Transcatheter aortic valve replacement (TAVR) has become the standard of care for patients with severe aortic stenosis (AS) who are at elevated surgical risk. Although generally well tolerated, TAVR can be associated with uncommon but potentially serious complications, including acute mitral regurgitation (MR) following valve deployment.

We present the case of a 94-year-old woman with symptomatic severe AS who developed acute, new-onset severe MR immediately after TAVR. Preprocedural imaging had shown no significant MR. The patient experienced acute hemodynamic compromise with pulmonary edema and hypotension, necessitating prompt medical intervention with vasopressors, diuretics, and noninvasive ventilation. Postoperative imaging excluded structural mitral valve (MV) damage and suggested impaired leaflet coaptation. The severity of MR improved markedly over the subsequent days, and at 1-year follow-up, only trace MR was observed. The likely mechanism was transient ischemic dysfunction of the posteromedial papillary muscle due to hypotension.

New-onset severe MR following TAVR is an uncommon yet clinically significant complication that necessitates prompt identification and intervention. In cases where intraprocedural hypotension occurs, transient papillary muscle dysfunction should be considered as a potential underlying mechanism, particularly when the MR is reversible and not associated with structural MV abnormalities or evidence of myocardial ischemia.