Restoration of a Stuck Leaflet

TL;DR

This paper presents a case where a stuck leaflet after a heart valve procedure caused severe complications, which were resolved through quick diagnosis and intervention.

Contribution

The paper highlights a rare but critical complication of TAVI and emphasizes the importance of prompt recognition and management.

Findings

Severe central aortic regurgitation due to a stuck leaflet can cause hemodynamic instability after TAVI.

Catheter manipulation successfully corrected the stuck leaflet, stabilizing the patient's condition.

Prompt diagnosis and intervention are crucial to reduce morbidity and improve outcomes in such cases.

Abstract

Severe aortic regurgitation (AR) for a leaflet malfunction after transcatheter aortic valve implantation (TAVI) is a dreadful complication that can lead even to cardiogenic shock. New valve's design has reduced the rate of paravalvular regurgitation, however central regurgitation is still a challenging complication. An 88‐year‐old woman with severe aortic stenosis underwent TAVI with an Edwards Sapien III valve. After the procedure, angiography revealed third‐degree angiographic central AR, causing hemodynamic instability. The team suspected a stuck leaflet and corrected it with catheter manipulation. The patient's condition stabilized, and follow‐up echocardiography showed proper valve position and function. Severe AR following TAVI, while rare, can result in critical clinical deterioration. Recent evidence suggest that even mild grade of AR post‐TAVI can affect long‐term outcomes. This case has the aim to promote a prompt diagnosis and intervention on a stuck leaflet to reduce patient morbidity, hospitalization time, and resource utilization. This case illustrates the warning scenario of a severe central AR for a stuck leaflet after TAVI. Prompt recognition and management of this complication are crucial to improving clinical outcomes.

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