Critical Aortic Stenosis With Rapid Multiorgan Decompensation Reversed by Emergency TAVR

Critical aortic stenosis can deteriorate abruptly from compensated disease to low-output shock and multiorgan dysfunction. We describe rapid multiorgan decompensation from severe bicuspid aortic stenosis with recovery following emergency transcatheter aortic valve replacement (TAVR).

A previously active 69-year-old man with severe bicuspid aortic stenosis re-presented to the emergency department with pulmonary edema and rapidly progressive breathlessness. Although systolic blood pressure was preserved, he had severe hypoperfusion with lactate 8.6 mmol/L, alanine aminotransferase 5,379 IU/L, international normalized ratio 2.8, creatinine 189 μmol/L, and bilirubin 48 μmol/L. Repeat echocardiography demonstrated new biventricular dysfunction, functional mitral regurgitation, and a high probability of pulmonary hypertension. He underwent emergency transfemoral TAVR, which reduced the gradient from 129 to <10 mm Hg. The biochemical abnormalities improved within 48 hours, and he was discharged well 8 days later.

This case illustrates rapid, reversible multiorgan decompensation caused by critical aortic stenosis.

Deteriorating critical aortic stenosis should prompt urgent reassessment and expedited intervention. Emergency TAVR can restore forward flow and facilitate rapid physiologic recovery.