scholarly journals Obstruction of 2 Coronary Arteries from Different Causes Immediately after Transapical Transcatheter Aortic Valve Replacement

2020 ◽  
Vol 47 (1) ◽  
pp. 30-34
Author(s):  
Umihiko Kaneko ◽  
Ryuji Koshima ◽  
Hirosato Doi ◽  
Tsutomu Fujita
Keyword(s):  
Coronary Artery ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Coronary Arteries ◽  
Transcatheter Aortic Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Rare Complication ◽  
Left Main ◽  
Transcatheter Aortic Valve

Coronary obstruction, a rare complication of transcatheter aortic valve replacement, can be fatal. Few data exist on this phenomenon, and, to date, authors have reported only single coronary lesions. We present a case in which 2 coronary arteries obstructed immediately after transapical transcatheter aortic valve replacement. The patient was an 81-year-old woman with symptomatic severe aortic stenosis who underwent transapical transcatheter aortic valve replacement. Immediately after an Edwards Sapien XT valve was deployed, she experienced sudden cardiogenic shock resulting from obstruction of the left main coronary artery ostium and the distal left anterior descending coronary artery. The left main obstruction was caused by direct compression from a large calcified mass and the valve frame. The left anterior descending coronary artery obstruction was caused by ambient myocardial tightening and external compression around the apical sutures. Revascularization was achieved through coronary stent placement and suture removal, respectively. Our patient's case highlights the risk for coronary obstructions after transapical transcatheter aortic valve replacement, and we discuss how they can be managed.

scholarly journals Case Report: Post transcatheter aortic valve replacement shock: Value of multimodal imaging

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 2032 ◽  
Author(s):  
Sujatha P. Bhandary ◽  
Andrew J. Otey ◽  
Thomas J. Papadimos ◽  
Juan A. Crestanello ◽  
Barry S. George ◽  
...  
Keyword(s):  
Case Report ◽  
Coronary Artery ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Multimodal Imaging ◽  
Left Main Coronary Artery ◽  
Left Main ◽  
Transcatheter Aortic Valve

Complications resulting from the delayed clinical presentation of a left main coronary artery obstruction can be catastrophic. This case report presents a 73-year-old woman with severe aortic stenosis who underwent transcatheter aortic valve replacement with a core valve who, approximately 20 minutes after heparin reversal with protamine, became hypotensive and was unresponsive to vasopressor and inotropic therapy. Transesophageal echocardiography demonstrated global hypokinesis, which was highly consistent with the occlusion of the left main coronary artery. Angiography confirmed this diagnosis and demonstrated that valve positioning had not changed compared to post-placement examination. Here we report the partial covering of the ostium of the left main coronary artery by a core valve skirt that converted into a total occlusion following the initiation of heparin reversal with protamine and the value of multimodal imaging in the management of this case.

scholarly journals Left Main Coronary Artery Obstruction by Dislodged Native-Valve Calculus after Transcatheter Aortic Valve Replacement

2014 ◽  
Vol 41 (4) ◽  
pp. 414-417 ◽  
Author(s):  
Tahir Durmaz ◽  
Huseyin Ayhan ◽  
Telat Keles ◽  
Abdullah Nabi Aslan ◽  
Kemal Esref Erdogan ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Left Main Coronary Artery ◽  
Left Main ◽  
Transcatheter Aortic Valve ◽  
Artery Obstruction

Transcatheter aortic valve replacement can be an effective, reliable treatment for severe aortic stenosis in surgically high-risk or ineligible patients. However, various sequelae like coronary artery obstruction can occur, not only in the long term, but also immediately after the procedure. We present the case of a 78-year-old woman whose left main coronary artery became obstructed with calculus 2 hours after the transfemoral implantation of an Edwards Sapien XT aortic valve. Despite percutaneous coronary intervention in that artery, the patient died. This case reminds us that early recognition of acute coronary obstruction and prompt intervention are crucial in patients with aortic stenosis who have undergone transcatheter aortic valve replacement.

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