Key result
TAVR triggers hemodynamic collapse from simultaneous coronary and dynamic LVOT obstruction in a 94-year-old woman.
Why the study?
TAVR is established for severe AS, but rare complications can become life-threatening, particularly in anatomically high-risk patients.
Case Report (n=1)
This case highlights the diagnostic complexity and contradictory management strategies required when simultaneous coronary artery obstruction and dynamic LVOTO with SAM-associated MR occur after TAVR.
Clinicians should suspect concurrent coronary and dynamic LVOTO mechanisms in post-TAVR collapse; case report leaves open optimal diagnostic and management strategies.
Background Transcatheter aortic valve replacement (TAVR) is an established therapy for severe aortic stenosis (AS), but rare complications can rapidly become life-threatening, particularly in anatomically high-risk patients. Case Summary A 94-year-old woman with very severe AS underwent transfemoral TAVR using a self-expanding valve. After transcatheter heart valve implantation, she developed hemodynamic collapse with right coronary artery obstruction and severe mitral regurgitation (MR). At that time, the etiology of the severe MR could not be clearly identified. Although intra-aortic balloon pump (IABP) was initiated, cardiac arrest occurred, requiring extracorporeal membrane oxygenation (ECMO). Percutaneous coronary intervention was unsuccessful, necessitating conversion to coronary artery bypass grafting. ECMO was discontinued on postoperative day 1, but recurrent hemodynamic collapse developed under IABP support, revealing left ventricular outflow tract obstruction (LVOTO) and severe MR with systolic anterior motion (SAM). Discontinuing IABP and initiating medical therapy rapidly stabilized hemodynamics. Discussion This case illustrates the diagnostic and hemodynamic complexity of simultaneous coronary artery obstruction and dynamic LVOTO with SAM–associated MR after TAVR. Because management strategies for these conditions are inherently contradictory, identifying the dominant mechanism of shock can be challenging. Although severe MR was initially attributed to ischemia secondary to coronary obstruction, retrospective echocardiographic review demonstrated early SAM. Subsequent changes in loading conditions and myocardial contractility unmasked LVOTO. This case emphasizes the importance of repeated echocardiographic assessment and stepwise hemodynamic reassessment when multiple mechanisms of instability coexist after TAVR.
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Kawahira et al. (2026) conducted a case report in Severe aortic stenosis (n=1). Transcatheter aortic valve replacement was evaluated on Hemodynamic collapse. Transcatheter aortic valve replacement in a 94-year-old woman resulted in hemodynamic collapse due to simultaneous coronary artery obstruction and dynamic left ventricular outflow tract obstruction.
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