Prosthesis-to-Prosthesis Balloon Interaction During TAVR Causing Aorto-Mitral Curtain Injury and Left Ventricular...

Transcatheter aortic valve replacement (TAVR) in patients with previous mitral valve replacement presents unique procedural challenges because of altered left ventricular outflow tract anatomy and potential prosthesis-to-prosthesis interaction.

An 82-year-old woman with a 27-mm Medtronic Mosaic bioprosthetic mitral valve replacement underwent balloon-expandable valve TAVR for severe symptomatic aortic stenosis complicated by aorto-mitral curtain injury and a contained left ventricular pseudoaneurysm. Balloon interaction with the protruding mitral bioprosthesis likely caused the injury. Shortly after discharge, she presented with worsening dyspnea and back pain, and multimodality imaging demonstrated a contained pseudoaneurysm adjacent to the mitral prosthesis. Conservative management was pursued because of prohibitive surgical risk and hemodynamic stability, with close clinical and imaging surveillance.

This case highlights prosthesis-to-prosthesis interaction as a potential mechanism of aorto-mitral curtain injury during TAVR.

Aorto-mitral curtain injury after TAVR may present subacutely and require prompt multimodality imaging. Conservative management may be reasonable in selected hemodynamically stable patients.