CASE 1—2016 Problem-Solving in Transcatheter Aortic Valve Replacement: Cardiovascular Collapse, Myocardial Stunning, and Mitral Regurgitation

Acute Decompensated Heart Failure after Transcatheter Aortic Valve Implantation: A Case Report

“…2 ADHF may also occur after TAVI from numerous causes including LV dysfunction (due to coronary obstruction, "stunning" via rapid pacing, or stress induced cardiomyopathy), arrhythmia, annular rupture, pericardial effusion, mitral valve insufficiency, peripheral vascular injury, and a "suicide ventricle" (hyperdynamic intraventricular obstruction after unloading by TAVI). [2][3][4][5] In the present case, the possibility of coronary obstruction due to an implanted aortic valve was considered low as the patency of the coronary artery was confirmed through an aortogram post-TAVI. During the progression of cardiogenic shock, neither ST segment changes nor ventricular arrhythmias, such as ventricular fibrillation or ventricular tachycardia, were observed on ECG monitoring.…”

“…Ventricular stunning is an established clinical entity that has already been described in TAVI. 3,[9][10][11] Both RVP and BAV induce short periods of myocardial ischemia that can precipitate cardiogenic collapse due to profound ventricular stunning in susceptible patients. Patients with coronary artery disease, with greatly reduced oxygen levels during RVP, or patients with marked LV hypertrophy, which may increase oxygen demand, are at risk of myocardial ischemia during RVP.…”

Myocardial Stunning With Severe Functional Mitral Regurgitation in Transcatheter Aortic Valve Replacement ― Temporal Change in Transesophageal Echocardiographic Findings ―

“…etiology of myocardial stunning has not been fully elucidated, but the rapid ventricular pacing may be involved in this event. 1 Although myocardial stunning is transient, this case suggests that expeditious cardiopulmonary resuscitation with VA-ECMO contributes to full recovery from this ing state. Myocardial stunning is a rare but noteworthy complication.…”

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

“…Therefore, rapid diagnosis and appropriate management according to the precise mechanisms are mandatory. Although TAVR is increasingly performed using a “minimalist approach” under local anesthesia without TEE monitoring for selected patients [ 3 ], many authors have reported the superiority of using TEE compared with transthoracic echocardiography to detect the degree and mechanism of new or worsening MR [ 2 , 4 ]. In the present case, severe MR caused by complicated mechanisms (LV dyssynchrony and myocardial ischemia with papillary muscle dysfunction) were clearly detected by TEE.…”