Malposition of the Aortic Valve After TAVI with Consequent Severe Aortic Regurgitation

Male, 63 years old, with a long-term history of ischemic heart disease. After an myocardial infarction 20 years ago, a surgical evascularization was performed with left interior mammary artery (LIMA) – left anterior descending (LAD) bypass. Elective percutaneous coronary intervention (PCI) with the implantation of one bare metal stent in the circumfl ex artery was done 4 years ago. During this procedure, an indication for transcatheter aortic valve implantation (TAVI) was set due to the progression of stenosis gradient in the bicuspid aortic valve. Immediately after the TAVI procedure, the patient developed symptoms and signs of acute heart failure due to the malposition of the aortic valve and consequent severe aortic regurgitation (AR)(1). The images depict a transesophageal echocardiographic examination after TAVI (Figure 1-4). Severe AR with paravalvular jets is the result of the malposition of the biological valve after TAVI, where the valve partially occupies the left ventricular outfl ow tract. The inadequately positioned aortic val-ve was surgically removed, followed by the implantation of a mechanical aortic valve. Subsequently, as the patient was dependent on a temporary pacemaker, a permanent dual-chamber pacemaker was implanted. Following the surgical treatment, the patient recovered successfully (2,3).