The Journal of invasive cardiology
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The recent development of transcatheter aortic valve implantation (TAVI) for patients with severe aortic stenosis (AS) offers a feasible option for high-risk surgical patients. However, several complications are specifically related to this technique. The present case describes a novel complication associated with TAVI, a severe paravalvular leak related to "stretch-induced" peri-aortic hematoma. The possible mechanisms of this complication, as well as its potential solutions, are discussed.
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A 68-year-old African American female with a prior medical history of hypertension and dyslipidemia presented with sudden onset pressure-like substernal chest pain. Initial ECG showed no ST or T wave abnormalities, and troponin elevation of 2.88 ng/mL. ⋯ We successfully treated with balloon angioplasty followed by placement of 3 drug-eluting stents resulting in TIMI-3 flow; further testing for vasculitis was negative. Once spontaneous coronary artery dissection is diagnosed, the approach to treatment is controversial and treatment should be patient tailored.