Very late ventricular displacement of transcatheter aortic valve resulting in severe paravalvular regurgitation.
Prakash R, Crouch G, Joseph MX, Bennetts J, Selvanayagam JB, Sinhal A.
JACC Cardiovasc Interv. 2014;7(2):e13-e15. doi:10.1016/j.jcin.2013.06.019
Abstract
Case Study
A 74-year-old man presented to our center with acute pulmonary edema. This was in the context of a transfemoral transcatheter aortic valve replacement (TAVR) with a 26-mm Sapien XT valve (Edwards Lifesciences, Irvine, California), 63 days before. Mild paravalvular regurgitation (PVR) had been noted both immediately after the procedure and before discharge on day 3, which remained unchanged on transthoracic echocardiography (TTE) on day 20.
Transcatheter aortic valve dislocation, albeit a rare phenomenon, has been documented both early (<7 days) and late (>30 days), but no incidences as delayed as this case have been reported. The mechanism of the late transcatheter aortic valve displacement resulting in severe PVR, in this case, was likely a combination of under-sizing of the valve, the relative nonuniformity, and the paucity of annular calcification. A single imaging modality to assess the annulus was used then with 2-dimensional TEE, which may have underestimated the annular dimensions. The current practice of using complementary imaging modalities such as 2-dimensional TEE and multislice computed tomography will provide a more accurate assessment of annular dimensions and degree of calcification, aiding in better valve size selection.