Iatrogenic mitral stenosis following transcatheter aortic valve replacement (TAVR)

Abstract

A 57 year old female underwent transcatheter aortic valve replacement (TAVR) for severe aortic stenosis. Mild iatrogenic mitral stenosis was noted intraoperatively. Attempts to reposition the device were hampered by aortic angulation. One year later, severe mitral stenosis was confirmed on transoesophageal echocardiography. It is important to recognise that iatorgenic mitral stenosis due to TAVR may progress over time. Care should be taken to minimise the risk of this rare complication.

Fig. 1

Panel A fluoroscopy left anterior oblique projection showing the aortic root (Ao) and the struts of the CoreValve below the annulus of the aortic valve. TOE probe (small arrow). Panel B transoesophageal (TOE) mid oesophageal long-axis view showing CoreValve in situ and struts impinging on the anterior mitral valve leaflet (AMVL) short arrow. Panel C (12 month follow-up) TOE modified mid oesophageal 4 chamber view showing CoreValve struts impinging on a AMVL (left) and color flow Doppler showing a high velocity jet through the restricted mitral valve in diastole (right). Panel D (12 month follow-up) continuous wave Doppler through mitral valve showing severe mitral stenosis (Peak gradient 19 mmHg and mean gradient 12 mmHg).