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

Abstract

Pre-procedure mitral regurgitation (MR) is a frequent coexistent finding in patients undergoing transcatheter aortic valve replacement (TAVR), and most of them (up to 55%) experience a significant improvement in MR after the procedure. Although seldom described, mitral valve perforation after TAVR is a potentially serious complication that physicians should be aware of, as moderate or severe MR in TAVR recipients is associated with a high early mortality rate. We herein describe the case of a 65-year-old man presenting with worsening heart failure symptoms 5 months after TAVR due to an intraprocedural anterior mitral leaflet perforation and discuss the diagnostic process and therapeutic course of the case. Furthermore, we draw attention to the essential role of echocardiography in the management of TAVR procedures, taking into account its ability in detecting early complications, and emphasize the value of CT as a main determinant to predict long-term MR improvement after TAVR and to assess the potential candidates for double valve repair with percutaneous techniques.

Interference between Venus-A Valve and Anterior Mitral Valve Leaflets after Transcatheter Aortic Valve Replacement: Insight from FEops HEARTguide simulation

“…However, in a recently published case report, AML perforation occurred immediately after balloon predilatation due to folded leaflet calcifications distributed at the level of the non-coronary sinus toward the medial aspect of the mitral-aortic curtain (23). The authors considered that the distribution of bulky calcifications could also play a role in AML injury during TAVR procedure (23). In the present study, we further recognised several other potential risk factors, such as shorter mitral-aortic annulus distance, use of a larger prosthesis valve, and less calcification of the non-coronary cusp.…”

“…As mentioned previously, deep implantation of a long-frame prosthesis is a significant risk factor for PAI. However, in a recently published case report, AML perforation occurred immediately after balloon predilatation due to folded leaflet calcifications distributed at the level of the non-coronary sinus toward the medial aspect of the mitral-aortic curtain (23). The authors considered that the distribution of bulky calcifications could also play a role in AML injury during TAVR procedure (23).…”