Key result
Calcified valve detachment during TAVI causes bilateral stroke, upper extremity ischemia, and transient AV block.
Why the study?
Surgical manipulation during TAVI carries a risk of detaching aortic valve lesions, potentially leading to various embolic complications.
Case Report (n=1)
No
This case highlights the risk that detachment of calcified aortic valve lesions during TAVI can cause embolisms not only in the brain but also in the extremities and potentially the coronary arteries leading to conduction blocks.
Alerts to multi-territory embolic risks including conduction block during TAVI; leaves open preventive strategies in severe calcification.
BACKGROUND: Transcatheter aortic valve implantation (TAVI) is a minimally invasive surgery. However, there is a risk of surgical manipulation causing detachment of a lesion of the aortic valve, which can result in various embolisms. CASE PRESENTATION: An 87-year-old woman with symptomatic severe aortic valve stenosis was scheduled for transfemoral TAVI under monitored anesthesia. Preoperative examination revealed severe calcification of the aortic valve, but there was no calcification in the ascending aorta. After a delivery catheter system passed the aortic valve, left radial arterial pressure dropped significantly, and complete atrioventricular block (CAVB) occurred. Catecholamine administration and ventricular pacing improved hemodynamics, and a self-expandable valve was implanted. CAVB resolved after surgery, but her state of consciousness was poor, and her left hand became ischemic. Imaging studies revealed multiple embolic infarcts in her bilateral cerebrum and cerebellum. CONCLUSIONS: It should be noted that there is a risk of detachment of a calcified lesion of the aortic valve during TAVI, which can cause embolisms not only in the brain but also in the extremities and coronary arteries.
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Mitsuta et al. (2023) conducted a case report in Severe aortic valve stenosis (n=1). Transcatheter aortic valve implantation (TAVI) was evaluated. Detachment of a calcified aortic valve lesion during TAVI in an 87-year-old woman caused bilateral multiple stroke, left upper extremity ischemia, and transient complete atrioventricular block.
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