Acute torrential mitral regurgitation during transcatheter aortic valve replacement: a case report

Abstract

BackgroundTranscatheter aortic valve replacement (TAVR) is a minimally invasive approach to aortic valve replacement. However, critical cardiovascular collapse can occur during the procedure for various reasons.Case presentationA 90-year-old man with severe aortic stenosis and left circumflex artery stenosis developed acute torrential mitral regurgitation (MR) during TAVR. The valve deployment process induced left ventricular dyssynchrony due to left bundle-branch block and myocardial ischemia in the left circumflex artery region with torrential MR. Transesophageal echocardiography clearly demonstrated the mechanisms of MR, which was successfully bailed out by left ventricular pacing and intra-aortic balloon pumping.ConclusionsMR can be seriously exaggerated by various and complicated mechanisms during TAVR and should be rapidly assessed and appropriately managed depending on its mechanisms.Electronic supplementary materialThe online version of this article (10.1186/s40792-018-0446-z) contains supplementary material, which is available to authorized users.

Rare Cause of Severe Mitral Regurgitation after TAVI: Case Report and Literature Review

“…Secondary MR mechanisms encompass new-onset LBBB, LV dyssynchrony, and myocardial ischemia with papillary muscle dysfunction, cardiac tamponade, systolic anterior motion (SAM) of the mitral valve leaflet, and significant paravalvular leakage [30][31][32].…”

“…As TAVR is rapidly becoming a routine for the treatment of symptomatic severe AS in patients with a prohibitive surgical risk on account of its minimal invasiveness and comparable good short-and mid-term outcomes [31], careful attention should be paid to acute changes in the degree of MR, which have to be promptly assessed and adequately managed. Persistent significant or worsening MR following TAVR may be particularly important in patients who develop a significant paravalvular leak.…”

Atypical Presentation of Acute Mitral Regurgitation Secondary to Papillary Muscle Rupture

“…Non-ischemic MR includes all other causes such as myxomatous valve disease, infective endocarditis, blunt chest trauma, rheumatic heart disease, spontaneous rupture, and dynamic left ventricular outflow obstruction. Additionally, iatrogenic causes of acute MR have been reported rarely in patients undergoing transcatheter aortic valve implantation [ 7 ] and removal of transaortic left ventricular assist devices [ 8 ] due to trauma to the leaflets or chords.…”