Leaflet thrombosis after transcatheter aortic valve implantation: a case report
Abstract
We herein report the case of a 80-year old man with symptomatic degenerative aortic stenosis (peak gradient 58 mmHg, mean gradient 38 mmHg, valve area 0.9 cm2) and haemodynamically significant left main coronary artery (LM) and anterior descending artery (LAD) stenosis with fractional flow reserve of 0.72. Because of the age and significant degenerative spine disorder, the patient refused open heart surgery. We first performed percutaneous coronary intervention (PCI) on the LM and LAD, which was followed by staged transcatheter aortic valve implantation (TAVI) with self- expandable device. There was no significant aortic regurgitation and mean aortic gradient was 12 mmHg. After 4 months, mean gradient increased to 23 mmHg and this was associated with worsening of the patient’s exercise capacity. Computed contrast-enhanced tomography of the aorta showed thrombosis of the left and non-coronary cusps with decreased leaflet mobility. Stents in the LM and LAD were widely patent without significant in-stent restenosis. Acetylsalicilic acid was stopped and coumadin added to clopidogrel. After 4 months, mean gradient was 9 mmHg. After additional 3 months of anticoagulation therapy, it was 12 mmHg. Oral anticoagulation was therefore stopped and acetylsalicylic acid restarted.
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References
De Backer O, Bieliauskas G, Søndergaard L. Current status and future perspectives for transcatheter and surgical aortic valve replacement: the role of aortic valve surgery in the era of transcatheter-based therapies. EuroIntervention. 2018 Oct;14(9):e965–7. https://doi.org/10.4244/EIJV14I9A172 PMID:30307396
Deutsch MA, Scotten LN, Siegel R, Lange R, Bleiziffer S. Leaflet thrombosis and clinical events after TAVR: are paravalvular leaks a crucial trigger? EuroIntervention. 2018 Aug;14(6):716–7. https://doi.org/10.4244/EIJ-D-18-00348L PMID:30122662
Rashid HN, Cameron JD, Brown AJ. Activation of the coagulation cascade and the role of paravalvular leak in the development of leaflet thrombosis following transcatheter aortic valve replacement. EuroIntervention. 2018 Aug;14(6):718–9. https://doi.org/10.4244/EIJ-D-18-00348R PMID:30122663
Vavuranakis M, Kalogeras K, Kolokathis AM, Vrachatis D, Magkoutis N, Siasos G, et al. Antithrombotic therapy in TAVI. J Geriatr Cardiol. 2018 Jan;15(1):66–75. PMID:29434628
Mylotte D, Andalib A, Thériault-Lauzier P, Dorfmeister M, Girgis M, Alharbi W, et al. Transcatheter heart valve failure: a systematic review. Eur Heart J. 2015 Jun;36(21):1306–27. https://doi.org/10.1093/eurheartj/ehu388 PMID:25265974
Ruparelia N. Oral Anticoagulant Therapy for Early Post-TAVI Thrombosis. Interv Cardiol. 2018 Jan;13(1):33–6. PMID:29593834
Testa L, Latib A. Assessing the Risk of Leaflet Motion Abnormality Following Transcatheter Aortic Valve Implantation. Interv Cardiol. 2018 Jan;13(1):37–9. PMID:29593835
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