Rare complication, but with no major repercussions after transcatheter valve implant

Introduction: Severe aortic stenosis has reserved prognostic when conservative therapy is proposed. There-fore, aortic valve implantation is the only cure of the severe aortic stenosis, with good impact over symptomatology and life expectations. Surgical replacement of the valve is usually the elected therapy, but for a certain segment of patients – the elder ones and the ones with multiple comorbidities, with prohibitive risks for valvular surgery, the transcatheter valve implant (TAVI) is the alternative therapy.
Case presentation: This is the study case of a 83 years old female, known with severe aortic stenosis for several years, highly symptomatic with cardiac failure class III NYHA phenomena, acute cardiac failure with repeated cardiogenic pulmonary edema, with indication for surgical valve replacement, but postponed until the present moment. The Heart Team decided for transcatheter aortic valve implantation. Percutaneous aortic valve has been implanted (Edwards 26) via right transphemoral puncture, with very good results, with no residual paraprotesys leak. But, during color doppler examination of the ejection tract of the LV, turbulent flow is detected, oriented to the RV, which suggests presence of a small Ventricular Septal Defect (with left-right shunt), of no hemodinamic importance, which is a very rare complication after TAVI. In addition, the patient displays an abnormal rhythm – complete AV block, which lasted for 48 hrs and eventually needed permanent cardio-stimulation.
Conclusions: TAVI is being associated with a series of potential complications – vascular, cerebral, miocardic, up to necessity of cardiac emergency surgery. The risks are, in general, low, between 0.2-.01%, some of them being possible to avoid or at least diminished, by using correctly the means of medical imagery and by selecting the correct access pathway. The case we presented shows the natural history of the symptomatic aortic valve, with unfavorable prognosis because of not eliminating the obstacle, where the aortic valve implantation was performed successfully, with post-procedure complications but of no hemodinamic significance and with favorable evolution afterwards.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)