Publication Date
2-1-2020
Journal
The Texas Heart Institute Journal
DOI
10.14503/THIJ-17-6497
PMID
32148450
Publication Date(s)
February 2020
Language
English
PMCID
PMC7046351
PubMedCentral® Posted Date
2-1-2020
PubMedCentral® Full Text Version
Post-Print
Published Open-Access
yes
Keywords
Aged, 80 and over, Aortic Valve Stenosis, Coronary Stenosis, Female, Heart Valve Prosthesis, Humans, Percutaneous Coronary Intervention, Prosthesis Design, Shock, Cardiogenic, Stents, Suture Techniques, Sutures, Transcatheter Aortic Valve Replacement, Treatment Outcome
Copyright
This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.
Abstract
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.