# Embolization of Left Ventricular Outflow Tract Calcification After TAVR With a Self-Expanding Valve

## TL;DR

A patient with severe aortic stenosis and calcified left ventricular outflow tract experienced embolization after valve replacement, highlighting risks of device interaction with calcification.

## Contribution

Demonstrates a rare complication of LVOT calcification embolization during TAVR with a self-expanding valve.

## Key findings

- Device manipulation during TAVR can disrupt and embolize previously immobile LVOT calcification.
- Emergency intervention successfully treated cardiogenic shock caused by embolized calcification.
- Partial retraction and opening of the valve may increase interaction with LVOT calcification.

## Abstract

Severe aortic stenosis with extensive left ventricular outflow tract (LVOT) calcification poses challenges during transcatheter aortic valve replacement.

An 85-year-old man with severe aortic stenosis and extensive annular-to-LVOT calcification underwent transcatheter aortic valve replacement with a Navitor system (Abbott). To avoid conduction disturbances, the valve was deployed within the membranous septum under intracardiac echocardiography guidance, using partial recapture and the distal opening technique. Immediately after the procedure, displaced LVOT calcification embolized the left main coronary artery, leading to cardiogenic shock. The patient was successfully treated with emergency percutaneous intervention and was discharged without other embolic events.

The LVOT calcification, which showed no mobility preoperatively, appeared mobile after the procedure, suggesting that device manipulation may have caused its disruption and embolization.

It is important to be aware of the possibility that a partially retracted, slightly opened self-expanding valve may interact with LVOT calcification.