Cardiogenic shock following balloon post-dilatation in TAVI:
A stuck leaflet and frozen cusp are reported complications following transcatheter aortic valve implantation (TAVI). These complications are rare but can drastically change haemodynamics and be potentially life-threatening; thus, their awareness during TAVI is indispensable.

Leaflet malfunction generally presents in one of the three leaflets of a prosthetic valve; however, published in the European Heart Journal Case Reports, the authors present a case where all three leaflets were simultaneously stuck.

A 94-year-old woman was referred to our cardiology department with severe aortic stenosis. She underwent transfemoral TAVI. After a 20 mm balloon was inflated, a 23 mm Sapien 3 valve was deployed. Since the delivery balloon slipped into the ventricle, the valve top was not fully expanded.

Post-dilatation using a 23 mm balloon was performed, which led to cardiogenic shock. Immediate cardiopulmonary resuscitation and venoarterial extracorporeal membrane oxygenation were provided. Since aortography and haemodynamics indicated severe aortic regurgitation and transoesophageal echocardiography depicted no leaflets inside the Sapien 3, it was confirmed that all leaflets were stuck.

The valve-in-valve procedure using the second 23 mm valve was successfully performed, and her haemodynamics dramatically improved. The patient was discharged 20 days later.

Learning points:-

• A stuck leaflet has been reported as a complication following transcatheter aortic valve implantation. This phenomenon is rare but can drastically change haemodynamics and be life-threatening; thus, its awareness is indispensable while performing transcatheter aortic valve replacement.

• The authors encountered a case that all three leaflets were simultaneously stuck just after post-dilatation. A leaflet structure of the valve may potentially have a mechanical factor for becoming stuck following post-dilatation, particularly in the deformed stent.

• In addition to rupture, a stuck leaflet should be considered as one of the major complications after post-dilatation even when using a new-generation balloon-expandable valve.

Read about the case in detail here: