Key result
PCI successfully treats delayed coronary obstruction from transcatheter valve endothelialization 8 months post-TAVI.
Why the study?
Delayed coronary obstruction is a rare but serious complication after transcatheter aortic valve implantation, with unclear mechanisms and treatment options.
Case Report (n=1)
PCI is a feasible treatment option for delayed coronary obstruction caused by THV endothelialization months after TAVI.
Answers are grounded in this paper and cite their sources.
Delayed coronary obstruction may present months after TAVI; this case leaves open the incidence, predictors, and surveillance needs.
BACKGROUND: Coronary obstruction is one of the serious complications associated with transcatheter aortic valve implantation (TAVI). Delayed coronary obstruction (DCO) is a rare manifestation of coronary obstruction. CASE SUMMARY: A 91-year-old woman was diagnosed with severe aortic stenosis. She underwent TAVI with a self-expandable valve, without any complications. After 8 months, she was readmitted to our hospital for effort angina. Transthoracic echocardiogram and myocardial scintigraphy suggested left coronary artery ischaemia. Computed tomography revealed that the transcatheter heart valve (THV) frame was covered with a low-density mass that occluded the left coronary sinus (LCS). Transoesophageal echocardiogram showed a Doppler signal flowing from the non-coronary sinus to the LCS through the roundabout route between the aortic wall and the THV. Percutaneous coronary intervention was performed for the roundabout route. Although intravascular ultrasound after the implantation of one drug-eluting stent showed the underexpansion of the stent, another stent deployment improved the expansion. After the procedure, her symptom improved. DISCUSSION: Reportedly, the mechanism of DCO occurring months or years after TAVI is thought to be thrombus formation or THV endothelialization. In our case, the low-density mass was considered to be endothelium which developed along the THV frame. Low sinotubular junction height and higher THV position could be the underlying mechanisms of DCO. Percutaneous coronary intervention is a possible treatment option for DCO caused by THV endothelialization.
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Takiguchi et al. (2020) conducted a case report in Delayed coronary obstruction post-TAVI (n=1). Percutaneous coronary intervention was evaluated on Symptom improvement and stent expansion. Percutaneous coronary intervention successfully treated delayed coronary obstruction caused by transcatheter heart valve endothelialization 8 months after TAVI in a 91-year-old woman.
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