Critical Aortic Stenosis With Rapid Multiorgan Decompensation Reversed by Emergency TAVR

BACKGROUND: Critical aortic stenosis can deteriorate abruptly from compensated disease to low-output shock and multiorgan dysfunction. We describe rapid multiorgan decompensation from severe bicuspid aortic stenosis with recovery following emergency transcatheter aortic valve replacement (TAVR). CASE SUMMARY: A previously active 69-year-old man with severe bicuspid aortic stenosis re-presented to the emergency department with pulmonary edema and rapidly progressive breathlessness. Although systolic blood pressure was preserved, he had severe hypoperfusion with lactate 8.6 mmol/L, alanine aminotransferase 5,379 IU/L, international normalized ratio 2.8, creatinine 189 μmol/L, and bilirubin 48 μmol/L. Repeat echocardiography demonstrated new biventricular dysfunction, functional mitral regurgitation, and a high probability of pulmonary hypertension. He underwent emergency transfemoral TAVR, which reduced the gradient from 129 to <10 mm Hg. The biochemical abnormalities improved within 48 hours, and he was discharged well 8 days later. DISCUSSION: This case illustrates rapid, reversible multiorgan decompensation caused by critical aortic stenosis. TAKE-HOME MESSAGES: Deteriorating critical aortic stenosis should prompt urgent reassessment and expedited intervention. Emergency TAVR can restore forward flow and facilitate rapid physiologic recovery.