Sudden death after valve-in-valve procedure due to delayed coronary obstruction: a case report

Transcatheter Aortic Valve Implantation in a Patient With Anomalous Left Main Coronary Artery from Right Coronary Artery

Transcatheter aortic valve implantation (TAVI) is now a well-established modality of treating severe symptomatic aortic valve stenosis in patients deemed at great surgical risk. In patients with coexisting anomalous coronary arteries, however, TAVI presents technical challenges, and coronary obstruction is a feared complication. In this study, we present the case of successful TAVI in a 78-year-old patient with anomalous left main coronary artery originating from the right coronary artery.

[Delayed coronary obstruction of the left main artery after transcatheter aortic valve replacement]

Coronary arteries obstruction associated with transcatheter aortic valve implantation (TAVI) may occur either during the procedure or after it. In the latter coronary obstruction can be further divided into early (7 days after procedure) or delayed one (7 days). Delayed coronary obstruction (DCO) is referred as a rare but devastating complication after TAVI and is associated with the extremely high mortality. This case demonstrates the objective difficulties of timely diagnostics of DCO. Since the results of non-invasive methods are indetermined in most cases, the authors conclude that even low-specific clinical symptoms must be interpreted as the definite rationale for the implementation of invasive diagnostic and treatment strategy.

The Prophylactic Chimney Snorkel Technique for the Prevention of Acute Coronary Occlusion in High Risk for Coronary Obstruction Transcatheter Aortic Valve Replacement/Implantation Cases

Coronary occlusion (immediate or delayed) is an uncommon but potentially devastating complication of transcatheter aortic valve replacement/implantation (TAVR/TAVI). Several patient-related, anatomical, device and procedural risk factors can be assessed to risk-stratify patients and assist in procedural planning. In patients at high risk for coronary occlusion, coronary protection measures should be employed. In the highest risk patients, consideration should be given to prophylactic techniques to prevent coronary occlusion. This how-to-do-it report provides a framework for risk assessment for coronary occlusion followed by a step-wise description of the emerging chimney snorkel coronary stenting technique as a predictable procedural approach for the management of this potentially challenging clinical scenario.