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Frozen Leaflet During Transcatheter Balloon-Expandable Aortic Valve Implantation: Early Recognition and Safe
Graziella Pompei1, Carolina Moretti2, Manfredi Arioti2
1Department of Emergency, Internal Medicine, and Cardiology, Division of Cardiology, S. Maria delle Croci Hospital, Ravenna, Italy; Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy.
Background:
The occurrence of frozen or stuck leaflet during transcatheter aortic valve implantation (TAVI) is a rare but potentially fatal complication.
Case Summary:
An 83-year-old man was referred to an Italian Cardiology Unit for symptomatic severe aortic stenosis. The patient underwent transfemoral TAVI with a 26-mm Myval balloon-expandable valve. After deployment, severe aortic regurgitation was revealed by aortography. Transesophageal echocardiography showed hypomobility of one of the 3 leaflets. Unsuccessful attempts to restore mobility were made using a pigtail catheter and performing postdilation, requiring a valve-in-valve procedure, without any hemodynamic compromise.
Discussion:
Anatomical and procedural factors may be responsible for frozen leaflet during TAVI, predominantly reported with balloon-expandable valves. Transesophageal echocardiography enables rapid recognition, while angiography alone may be insufficient. A prompt hemodynamic support could be also required to avoid adverse procedural outcomes.
Conclusions:
A structured intervention algorithm and timely multidisciplinary involvement is essential to optimize outcomes in this high-risk situation.
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