TAVI complication: Prosthetic valve leaflet dislodgment after post-dilatation.

Abstract

Introduction and importance: Transcatheter aortic valve implantation (TAVI) is a minimally invasive procedure used to treat severe aortic stenosis. While TAVI is generally safe and effective, it can be complicated by rare adverse events such as prosthetic leaflet dislodgment leading to acute free aortic regurgitation.

Case presentation: We report the case of a female patient who experienced acute free aortic regurgitation following elective TAVI. This complication arose due to prosthetic leaflet dislodgment after post-dilatation of the implanted valve. The timely identification and management of this rare complication are essential to prevent potentially fatal outcomes.

Clinical discussion: The moderate paravalvular regurgitation (PVR) observed in this case was likely caused by the unsealing of heavily calcified aortic valve leaflets. While post-dilatation is a routine practice to optimize valve function, it poses the risk of serious complications, including leaflet dislodgment. Transoesophageal echocardiography (TEE) confirmed the loss of function of the prosthetic leaflet, which was likely exacerbated by aggressive post-dilatation techniques. The use of intravascular lithotripsy could be considered to mitigate the risk of significant PVR by effectively modifying the calcified valve structure.

Conclusions: Acute prosthetic leaflet dislodgment leading to free aortic regurgitation is a very rare but serious complication of TAVI. Early recognition and immediate intervention are crucial to manage this life-threatening event and optimize patient outcomes.