Possible early recoil phenomenon in a self-expandable transcatheter bioprosthesis compressed by a huge annular calcification

An 81-year-old woman was hospitalized for heart failure (HF) with severe aortic stenosis (AS). She had a history of liver transplantation under immunosuppressive therapy and multiple comorbidities. Our heart team considered her as a candidate for transcatheter aortic valve implantation (TAVI). Pre-screening multidetector computed tomography revealed the presence of a bulky calcification on the aortic root (Panel A). Therefore, a self-expandable transcatheter heart valve [THV; 26-mm CoreValve Evolut-R (Medtronic, USA)] was implanted via the femoral artery after balloon pre-dilatation (Panels B andC). Haemodynamic measurements showed a remarkable decrease in the peak pressure gradient (PG) between the left ventricle and aorta (Panels D andE). However, she was re-hospitalized for HF approximately 1 month after the initial TAVI procedure, which was associated with recurrent severe AS on echocardiography (Panel F). Multidetector computed tomography was performed to examine the THV performance, which revealed no THV thrombosis, but did indicate that the inferior portion of the THV was compressed by large, bilateral calcifications (Panel G). Fluoroscopy also identified shallowing of the THV in response to left ventricular outflow and a significant re-elevation of PG compared with the first procedure (Panels H andI). The distal portion of the self-expandable THV was the strongest available design, moreover, it was expected to expand gradually after TAVI. Nonetheless, it was hypothesi...
Source: European Heart Journal - Category: Cardiology Source Type: research