Tomarelli Elisa, Di Pietro Gianluca, Sardella Gennaro, Mancone Massimo
Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy.
Catheter Cardiovasc Interv. 2025 Jul;106(1):527-529. doi: 10.1002/ccd.31550. Epub 2025 May 8.
Severe aortic regurgitation (AR) for a leaflet malfunction after transcatheter aortic valve implantation (TAVI) is a dreadful complication that can lead even to cardiogenic shock. New valve's design has reduced the rate of paravalvular regurgitation, however central regurgitation is still a challenging complication. An 88-year-old woman with severe aortic stenosis underwent TAVI with an Edwards Sapien III valve. After the procedure, angiography revealed third-degree angiographic central AR, causing hemodynamic instability. The team suspected a stuck leaflet and corrected it with catheter manipulation. The patient's condition stabilized, and follow-up echocardiography showed proper valve position and function. Severe AR following TAVI, while rare, can result in critical clinical deterioration. Recent evidence suggest that even mild grade of AR post-TAVI can affect long-term outcomes. This case has the aim to promote a prompt diagnosis and intervention on a stuck leaflet to reduce patient morbidity, hospitalization time, and resource utilization. This case illustrates the warning scenario of a severe central AR for a stuck leaflet after TAVI. Prompt recognition and management of this complication are crucial to improving clinical outcomes.
经导管主动脉瓣植入术（TAVI）后因瓣叶功能障碍导致的严重主动脉瓣反流（AR）是一种可怕的并发症，甚至可能导致心源性休克。新型瓣膜设计降低了瓣周反流的发生率，然而中心性反流仍然是一种具有挑战性的并发症。一名88岁重度主动脉瓣狭窄女性接受了爱德华 Sapien III 瓣膜的TAVI手术。术后血管造影显示为三度血管造影中心性AR，导致血流动力学不稳定。团队怀疑瓣叶卡瓣，并通过导管操作进行了纠正。患者病情稳定，随访超声心动图显示瓣膜位置和功能正常。TAVI术后严重AR虽然罕见，但可导致严重的临床恶化。最近的证据表明，即使TAVI术后轻度AR也会影响长期预后。本病例旨在促进对卡瓣的及时诊断和干预，以降低患者发病率、住院时间和资源利用。本病例说明了TAVI术后因瓣叶卡瓣导致严重中心性AR的警示情况。及时识别和处理这种并发症对于改善临床结局至关重要。
