Transcatheter Aortic Valve Replacement in Aortic Regurgitation Secondary to Aortic Valvulitis.

OBJECTIVES

To evaluate the feasibility of off-label transcatheter aortic valve replacement in a 29-year-old man with severe aortic regurgitation (AR) who was not a surgical candidate because of systemic vasculitis.

KEY STEPS: The right radial artery was unsuitable because of small caliber and spasm, and the right common iliac artery was occluded, necessitating femoral access with serial dilation. The device was positioned under angiography and deployed during rapid pacing, with subsequent hypotension requiring resuscitation. Postprocedure, hemodynamics improved (mean gradient 3 mm Hg, no regurgitation). Arteriography revealed a left common iliac artery dissection, which was stented. Three-month follow-up confirmed appropriate valve positioning/function.

POTENTIAL PITFALLS: In pure AR, lack of annular/leaflet calcification-especially in younger patients-can impair anchoring. Vasculitis further complicates sizing/deployment and can limit access. Rapid pacing in poorly functioning ventricles carries a risk for cardiac arrest. Long-term durability of transcatheter aortic valve replacement in young patients remains uncertain, and its use for native AR in the United States remains off-label.