Coronary Obstruction Following Transcatheter Aortic Valve\nImplantation
A 89-year-old female, with history of hypertension, dyslipidemia and ischemic\ncardiomyopathy with previous percutaneous coronary intervention, was developing heart\nfailure functional class III (NYHA), being diagnosed with significant aortic stenosis\n(mean gradient: 83 mmHg; valve area: 0.60 cm2). Based on her age and high\nrisk (logistic EuroSCORE: 23.2%; STS-PROM: 5.4%), the patient was referred to TAVI,\nthat was performed by the transfemoral approach, with implantation of a 23 mm Sapien\nXT. Due to the presence of moderate periprosthetic aortic regurgitation,\npost-dilation was carried out. Control aortography and TEE revealed a decrease in\naortic regurgiration and the absence of other complications. However, 50 minutes\nafter procedure, the patient suddenly developed severe and maintained hypotension,\nand aortography showed obstruction of the LM ostium. Despite successful implantation\nof a bare-metal stent, the patient persisted in refractory cardiogenic shock, leading\nto death.