Coronary Obstruction Following Transcatheter Aortic Valve\nImplantation
A 83-year-old female, hypertensive, diabetic, with coronary artery disease and heart\nfailure functional class III (NYHA). In clinical evaluation, it was noted severe\naortic stenosis (mean gradient: 77 mmHg; valve area: 0.50 cm2) of high\nrisk (logistic EuroSCORE: 9.5%; STS PROM: 7.9%) being referred to TAVI. On\nangiotomography it was verified the sinus of Valsalva with mean diameter of 26 mm,\nvalve annulus of 24 mm and height of right coronary artery (RCA) and left main (LM)\nof 10.4 mm and 9.6 mm, respectively ().\nThe procedure was performed by transfemoral approach, with implantation of a 26 mm\nballoon-expandable Sapien XT prosthesis. Immediately after valve implantation, the\npatient evolved with severe and maintained hypotension, in addition to ST-segment\nelevation detected on cardiac monitoring. Transesophageal echocardiogram (TEE) showed\nappropriate bioprosthesis positioning, with mild perivalvular regurgitation. On\naortography it was detected complete obstruction of RCA ostium (). A condition of shock and cardiac arrest had quickly\nbegun, so that cardiopulmonary resuscitation and angioplasty with implantation of 2\ndrug-eluting stent of the RCA were successfully performed (). As a further complication, due to resuscitation\nprocedures, there was a perforation on right ventricle by temporary pacemaker and\ntamponade, and despite the treatment of the complications, there was another cardiac\narrest and subsequent death.