Shock after immediate TAVI implantation. Do we know what we are dealing with? How would I approach it?
HOW WOULD I APPROACH IT? This is a case of transcatheter aortic valve implantation (TAVI) (26 mm CoreValve Evolut). During the implant, the patient developed severe hypotension while at the cath lab. Both the angiography and the echocardiography performed discarded the common causes of hypotension a...
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| Format: | Article |
| Language: | English |
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Permanyer
2021-05-01
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| Series: | REC: Interventional Cardiology (English Ed.) |
| Online Access: | https://recintervcardiol.org/en/index.php?option=com_content&view=article&id=488 |
| Summary: | HOW WOULD I APPROACH IT? This is a case of transcatheter aortic valve implantation (TAVI) (26 mm CoreValve Evolut). During the implant, the patient developed severe hypotension while at the cath lab. Both the angiography and the echocardiography performed discarded the common causes of hypotension after TAVI: – Tamponade (the most common one, due to the pacemaker). There is no pericardial effusion. – Aortic rupture: it is caused during the valvuloplasty before and after the dilatations with self-expanding valves. There is no pericardial effusion or suggestive images on the echocardiography. – Coronary occlusion: it is discarded by injecting the left main coronary artery (LMCA). When the LMCA needs to be protected, the best thing to do is to leave a stent all the way into the left anterior descending coronary artery that should be long enough to provide coverage from before the LMCA bifurcation until above the leaflets of the implanted valve. – Vascular complications with hemorrhage. They can be discarded on an angiography. – Severe aortic regurgitation due to paravalvular leak or leaflet dysfunction of the transcatheter aortic valve. In this case only non-significant aortic regurgitation is seen. – Other less common causes of hypotension such as mitral regurgitation due to chordal or papillary muscle ruptures... |
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| ISSN: | 2604-7322 |