Key result
Prompt stenting and dual-chamber pacing successfully reverse post-TAVR LM and LVOT obstructions.
Case Report (n=1)
No
Concurrent coronary obstruction and LVOT obstruction after TAVR can be successfully managed with prompt bail-out coronary stenting and subsequent pacemaker implantation.
May support individualized rescue for rare post-TAVR obstructions; leaves open need for prospective validation.
Objective: Predicting coronary obstruction (CO) and left ventricular outflow tract (LVOT) obstruction (LVOTO) after transcatheter aortic valve replacement (TAVR) remains challenging.
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Tatami et al. (2026) conducted a case report in Elderly female patient (86 years old) with very severe aortic stenosis, sigmoid septum, systolic anterior motion of mitral valve, and mild mitral regurgitation, who developed left main coronary obstruction and worsening left ventricular outflow tract obstruction following transcatheter aortic valve replacement (n=1). Transcatheter aortic valve replacement (TAVR) using 23-mm Sapien 3 valve with left main coronary artery protection and bailout drug-eluting stenting of left main artery; subsequent optimal medical therapy and dual-chamber permanent pacemaker implantation was evaluated on Occurrence and management of left main coronary obstruction (LM obstruction) and left ventricular outflow tract obstruction (LVOTO) following TAVR with clinical and echocardiographic outcomes. Prompt left main coronary stenting successfully reversed LM obstruction after TAVR, and dual-chamber pacemaker implantation led to gradual improvement of worsening LVOT obstruction over 6 months from 6.4 m/s to 1.5 m/s peak velocity with resolution of SAM and mitral regurgitation.
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