4 years ago

Progressive breathlessness following transcatheter aortic valve replacement

An 84-year-old man presented urgently to the cardiology clinic with rapid onset exertional dyspnoea while walking on the flat. Five months previously, he underwent implantation of a balloon-expandable 26 mm transcatheter heart valve (SAPIEN 3, Edwards Lifesciences) for severe aortic stenosis. On clinical examination, the jugular venous pressure was elevated and a mid-late ejection systolic murmur was audible in the aortic region. ECG demonstrated sinus rhythm with a left ventricular (LV) strain pattern. Transthoracic echocardiography and cardiac CT were performed (figure 1). Figure 1

(A) Transthoracic continuous wave Doppler through the transcatheter AV. ECG-gated cardiac CT oblique reconstruction of the LV outflow tract and aortic root in mid-diastole (B) with axial reconstruction of the transcatheter AV in end-systole (inset). AT, acceleration time; AV, aortic valve; LV, left ventricular.


Which aetiology best explains this presentation?

  • Pannus formation

  • Transcatheter bioprosthetic valve endocarditis

  • Patient-prosthesis mismatch

  • Transcatheter bioprosthetic valve leaflet thrombosis

  • Structural valve degeneration

  • Publisher URL: http://heart.bmj.com/cgi/content/short/103/21/1703

    DOI: 10.1136/heartjnl-2017-312008

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