JACC. Case reports · 2026
Prosthesis-to-Prosthesis Balloon Interaction During TAVR Causing Aorto-Mitral Curtain Injury and Left Ventricular Pseudoaneurysm.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Youssef Mina, Ramadurgum Prerana, Botros Monica, Dadhania Khush, Rajachandran Manu S, Srinivas Sunil K, Roongsritong Chanwit
Аннотация
BACKGROUND: Transcatheter aortic valve replacement (TAVR) in patients with previous mitral valve replacement presents unique procedural challenges because of altered left ventricular outflow tract anatomy and potential prosthesis-to-prosthesis interaction.
CASE SUMMARY: An 82-year-old woman with a 27-mm Medtronic Mosaic bioprosthetic mitral valve replacement underwent balloon-expandable valve TAVR for severe symptomatic aortic stenosis complicated by aorto-mitral curtain injury and a contained left ventricular pseudoaneurysm. Balloon interaction with the protruding mitral bioprosthesis likely caused the injury. Shortly after discharge, she presented with worsening dyspnea and back pain, and multimodality imaging demonstrated a contained pseudoaneurysm adjacent to the mitral prosthesis. Conservative management was pursued because of prohibitive surgical risk and hemodynamic stability, with close clinical and imaging surveillance.
DISCUSSION: This case highlights prosthesis-to-prosthesis interaction as a potential mechanism of aorto-mitral curtain injury during TAVR.
TAKE-HOME MESSAGES: Aorto-mitral curtain injury after TAVR may present subacutely and require prompt multimodality imaging. Conservative management may be reasonable in selected hemodynamically stable patients.
CASE SUMMARY: An 82-year-old woman with a 27-mm Medtronic Mosaic bioprosthetic mitral valve replacement underwent balloon-expandable valve TAVR for severe symptomatic aortic stenosis complicated by aorto-mitral curtain injury and a contained left ventricular pseudoaneurysm. Balloon interaction with the protruding mitral bioprosthesis likely caused the injury. Shortly after discharge, she presented with worsening dyspnea and back pain, and multimodality imaging demonstrated a contained pseudoaneurysm adjacent to the mitral prosthesis. Conservative management was pursued because of prohibitive surgical risk and hemodynamic stability, with close clinical and imaging surveillance.
DISCUSSION: This case highlights prosthesis-to-prosthesis interaction as a potential mechanism of aorto-mitral curtain injury during TAVR.
TAKE-HOME MESSAGES: Aorto-mitral curtain injury after TAVR may present subacutely and require prompt multimodality imaging. Conservative management may be reasonable in selected hemodynamically stable patients.