Management of a Chronically Infolded Self-Expanding Aortic Valve

Infolding is a known complication of self-expandable transcatheter valves that typically causes hemodynamic compromise. Delayed diagnosis of infolding is rare and can result in premature leaflet degeneration, with limited treatment options.

A 71-year-old man presented 5 years after transcatheter aortic valve replacement (TAVR) with severe intravalvular regurgitation. Transesophageal echocardiography revealed significant infolding of the valve. The patient underwent valve-in-valve TAVR, which successfully resolved the aortic insufficiency.

This is the first reported case of a chronically infolded TAVR, which is a rare but significant complication of self-expandable valves. We demonstrate that valve-in-valve replacement can successfully overcome chronic frame distortion and endothelialization.

Transcatheter valve infolding does not necessarily cause significant hemodynamic changes, which can lead to delays in diagnosis and treatment. Chronic infolding can be visualized by 3D computed tomography and can result in premature leaflet degeneration. Structural distortion of self-expandable valves, even years after implant, can be overcome with high-pressure valvuloplasty and valve-in-valve replacement.