# Acute Left Main Coronary Embolization Following Transcatheter Aortic Valve Implantation

## TL;DR

A rare case of acute coronary embolization after a heart valve procedure was successfully treated with emergency intervention.

## Contribution

Reports a rare case of embolus-induced coronary occlusion after TAVI and its successful treatment with PCI.

## Key findings

- Acute left main coronary embolization occurred 30 minutes after TAVI in an 80-year-old woman.
- Immediate PCI restored coronary flow and the patient recovered well with no complications at one-year follow-up.
- Degenerated aortic valve tissue was likely the source of the embolus based on imaging findings.

## Abstract

Acute coronary occlusion just after transcatheter aortic valve implantation (TAVI) is a rare but fatal complication, with an incidence of less than 1% but a 30-day mortality rate of up to 50%. The most likely mechanism of acute coronary occlusion following TAVI is the obstruction by the native aortic valve leaflet. However, acute coronary occlusion due to embolus has been rarely reported, and we herein report the case. An 80-year-old woman with severe aortic stenosis and chronic myelogenous leukemia (CML) underwent transfemoral TAVI with a 23-mm balloon-expandable valve. Just before leaving an operation room about 30 minutes after the TAVI procedure, she went into cardiopulmonary arrest. Emergent coronary angiography showed the occlusion of the middle to the distal left main coronary artery with a large embolus. Percutaneous coronary intervention (PCI) was immediately performed, and a drug-eluting stent was eventually placed to improve good coronary flow. She was finally discharged on foot without any other complications and was doing well one year after TAVI with normal left ventricular systolic function and no in-stent restenosis. Considering the transthoracic echocardiography before TAVI and the intravascular ultrasound findings during PCI, it was most likely thought to be caused by the embolus of the degenerated aortic valve tissue. In conclusion, although acute coronary occlusion by embolization following the TAVI procedure is exceedingly rare, we could successfully rescue the patient with immediate PCI.