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Delayed left main coronary obstruction following transfemoral inovare transcatheter aortic valve replacement: A challenging case.

Authors :
Kanhouche G
Cividanes FR
Sampaio RO
da Silva JCA
Machado RD
Werneck M
Accorsi TAD
Morales KRP
Abizaid AC
Brito FS Jr
Tarasoutchi F
Palma JH
Ribeiro HB
Source :
Journal of cardiology cases [J Cardiol Cases] 2021 Jul 19; Vol. 25 (2), pp. 61-64. Date of Electronic Publication: 2021 Jul 19 (Print Publication: 2022).
Publication Year :
2021

Abstract

Coronary obstruction is an uncommon and severe complication after a transcatheter aortic valve replacement (TAVR), that occurs during the procedure in the vast majority of patients. In the present case even in the absence of classic risk factors, an acute coronary syndrome occurred one day after TAVR. Selective angiography revealed a severe left main ostium obstruction by the bulky native leaflet calcification. This is the first case of delayed presentation of coronary obstruction with a transfemoral balloon-expandable valve using the Inovare bioprosthesis (Braile Biomedica, Brazil). In addition, after drug-eluting stent placement in the left main coronary, intravascular ultrasound revealed severe stent underexpansion, so that a second layer of a bare-metal stent and high-pressure balloon post-dilatation was necessary to improve the final result. The patient was discharged after 7 days, and at the 6-month follow-up remained asymptomatic. < Learning objective: This case illustrates an unusual cause of an acute coronary syndrome 24 h after a transcatheter aortic valve replacement. This is the first report of this severe complication with delayed presentation following the balloon-expandable Inovare bioprosthesis. Even in the absence of classic risk factors this complication may occur, and percutaneous coronary intervention is feasible in the vast majority of cases, often requiring various percutaneous techniques and intravascular image to improve outcomes.>.<br /> (© 2021 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.)

Details

Language :
English
ISSN :
1878-5409
Volume :
25
Issue :
2
Database :
MEDLINE
Journal :
Journal of cardiology cases
Publication Type :
Report
Accession number :
35079298
Full Text :
https://doi.org/10.1016/j.jccase.2021.06.012