Acute Coronary Obstruction During Transcatheter Aortic Valve Implantation Caused by Suspected Calcified Amorphous Tumor Embolization

BACKGROUND: Coronary obstruction during transcatheter aortic valve replacement (TAVR) is a rare but catastrophic complication. Embolization from mitral valve structures, including cardiac calcified amorphous tumors, has been rarely reported. CASE SUMMARY: A 96-year-old woman with severe aortic stenosis underwent transfemoral TAVR with a self-expanding Evolut FX valve (Medtronic Inc). Intracardiac echocardiography identified a mobile calcified lesion attached to the posterior mitral leaflet that disappeared during valve deployment. Shortly after implantation, cardiogenic shock developed because of acute left main coronary obstruction. Emergent extracorporeal membrane oxygenation and a bailout percutaneous coronary intervention were successfully performed. Intravascular ultrasound demonstrated heterogeneous structures composed of calcified and soft-tissue components. DISCUSSION: Computed tomography suggested embolization of mitral annular calcification, possibly a cardiac calcified amorphous tumor, through the enlarged valve aperture. TAKE-HOME MESSAGES: Intracardiac mobile calcified lesions may be rare embolic sources of coronary obstruction during TAVR. Ironically, the enlarged-aperture design contributed to both coronary obstruction and the rapid bailout intervention.