Acute decompensated heart failure after transcatheter aortic valve implantation: A case report

Abstract

Transcatheter aortic valve implantation (TVAI) is a widely used treatment modality for severe aortic stenosis. The complication rates of the procedure have gradually decreased over time, owing to the improvements in procedural skills and development of TVAI devices. However, several rare but serious complications can still occur after TAVI. We recently encountered acute decompensated heart failure as a rare and fatal complication of TAVI and would like to share our experience.

Keywords: acute decompensated heart failure; left ventricular stunning; stress‐induced cardiomyopathy; suicide left ventricle; transcatheter aortic valve implantation.

FIGURE 1

On the day of admission, Chest X‐ray (A) revealed cardiomegaly, but pulmonary edema and pleural effusion were not observed. Initial electrocardiogram (B) showed sinus rhythm and left ventricular hypertrophy with QRS widening.

FIGURE 2

Initial transthoracic echocardiography (TTE) findings. (A, B) TTE showed left ventricular hypertrophy and degenerative aortic valve with severe calcification. (C) The aortic valve area (AVA) was 0.51 cm² on the planimetry. (D) The mean systolic pressure gradient of aortic valve was 95.50 mmHg, and peak aortic jet velocity was 6.23 m/s on the continuous wave Doppler.

FIGURE 3

Transcatheter aortic valve implantation (TAVI) procedure. (A) Pre‐balloon dilation was performed under rapid ventricular pacing (RVP). (B) An Edwards SAPIEN 3, 23 mm, prosthetic aortic valve was successfully implanted. (C) Post‐balloon dilation was performed under RVP to reduce paravalvular leakage.

FIGURE 4

Post TAVI procedural findings (A) Transesophageal echocardiography showed minimal paravalvular leakage (arrow). (B, C) Coronary artery blood flow was intact on aortography after the TAVI procedure.