Delayed coronary obstruction of the left main artery after transcatheter aortic valve replacement

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Abstract

Coronary arteries’ obstruction associated with transcatheter aortic valve implantation (TAVI) may occur either during the procedure or after it. In the latter coronary obstruction can be further divided into early (<7 days after procedure) or delayed one (>7 days). Delayed coronary obstruction (DCO) is referred as a rare but devastating complication after TAVI and is associated with the extremely high mortality. This case demonstrates the objective difficulties of timely diagnostics of DCO. Since the results of non-invasive methods are indetermined in most cases, the authors conclude that even low-specific clinical symptoms must be interpreted as the definite rationale for the implementation of invasive diagnostic and treatment strategy.

About the authors

A. E. Komlev

National Medical Research Center of Cardiology

Author for correspondence.
Email: pentatonika@bk.ru
ORCID iD: 0000-0001-6908-7472

кардиолог отд. сердечно-сосудистой хирургии

Russian Federation, Moscow

P. M. Lepilin

National Medical Research Center of Cardiology

Email: pentatonika@bk.ru
ORCID iD: 0000-0003-2979-2542

к.м.н., сердечно-сосудистый хирург, ст. науч. сотр. отд. сердечно-сосудистой хирургии

Russian Federation, Moscow

E. V. Kurilina

National Medical Research Center of Cardiology

Email: pentatonika@bk.ru

врач-патологоанатом

Russian Federation, Moscow

V. V. Romakina

National Medical Research Center of Cardiology

Email: pentatonika@bk.ru
ORCID iD: 0000-0002-0035-0794

кардиолог отд. сердечно-сосудистой хирургии

Russian Federation, Moscow

T. E. Imaev

National Medical Research Center of Cardiology

Email: pentatonika@bk.ru
ORCID iD: 0000-0002-5736-5698

д.м.н., сердечно-сосудистый хирург, гл. науч. сотр. отд. сердечно-сосудистой хирургии

Russian Federation, Moscow

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Supplementary files

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2. Fig. 1. ECG of the patient upon admission.

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3. Fig. 2. Measurement of trans-prosthetic systolic gradients on AK.

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4. Fig. 3. Preoperative CAG: a - LCA, b - right coronary artery.

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5. Fig. 4. MSCT aortography.

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6. Fig. 5. Intraoperative ChpEchoCG: a - the arrow indicates the flotation fragment of the left coronary valve of the AK immediately after balloon valvotomy of the AK; b - functioning bioprosthesis AK; additional formations in the projection of the coronary sinus are not visualized.

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7. Fig. 6. Control angiography.

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8. Fig. 7. ECG on the 1st day after the transfer from the intensive care unit.

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9. Fig. 8. ECG in dynamics (2nd postoperative day).

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10. Fig. 9. ECG at the time of a sharp deterioration.

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11. Fig. 10. Self-expanding bioprosthesis in the aortic position. A fragment of the split left coronary cusp of the native AK outlining the mouth of the LCA is outlined in blue.

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