Unusual cause of myocardial infarction following transcatheter aortic valve replacement

Key Clinical Message

Left coronary artery embolism from aortic valve leaflet tissue mass is a rare but potentially life‐threatening complication following transcatheter aortic valve replacement. It is important for interventional cardiologists to be aware of this rare complication for rapid identification and prompt treatment which is the key to a successful outcome.
Abstract An 81‐year‐old female presented for elective transcatheter aortic valve replacement (TAVR) for severe low‐flow low‐gradient aortic stenosis. Immediately post‐procedure, she developed unexplained, persistent hypotension. There was no bleeding. There was no aortic injury. Activated clotting time was in therapeutic range. Coronary angiography revealed hazy filling defects in left anterior descending and left circumflex. Intravascular ultrasound showed heterogeneous, hypoechoic mass with mild calcification consistent with embolized valve leaflet tissue. This was treated with emergent percutaneous coronary intervention with excellent results. Left coronary artery embolism from aortic valve leaflet tissue is a rare, but potentially life‐threatening complication following TAVR. Prompt recognition is key to a successful outcome.

Keywords: coronary thrombosis; left coronary artery embolism; myocardial infarction (MI); transcatheter aortic valve replacement (TAVR).