JACC. Case reports · 2026
Successful Balloon Valvuloplasty for Paravalvular Leak 4 Months After TAVR in a Bicuspid Aortic Valve.
Клинический случайСтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
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Mosaad Mohammed, Algazlan Saleh, Alshamardl Khalid, Alsalman Abdelmohsen, Omer Hafiz, Elneama Awadelkarim, Alghamedi Mohammed, Algathami Abdulaziz
Аннотация
BACKGROUND: Late detection of paravalvular leak (PVL) after transcatheter aortic valve replacement (TAVR) presents unique treatment challenges, especially in bicuspid valves, likely because of valve geometry and the mechanism of percutaneous anchoring.
CASE SUMMARY: A 70-year-old man underwent TAVR for bicuspid aortic stenosis using a balloon-expandable valve. Moderate to severe PVL was detected 4 months later. A multidisciplinary team evaluated the PVL etiology, patient anatomy, and available treatment options including valve-in-valve and plug closure. A partially fused commissural raphe causing focal underexpansion was identified as the origin of PVL, and late balloon valvuloplasty was performed successfully.
DISCUSSION: Unlike surgical-valve PVL, where percutaneous plug closure is the main treatment option, post-TAVR PVL offers additional approaches. Multimodality imaging helps define mechanism, feasibility, and risk.
TAKE-HOME MESSAGES: Late balloon valvuloplasty is a safe option for underexpanded TAVR in bicuspid valves. Assessment of calcified raphe anatomy and the underexpansion site guides procedural risk and informs treatment selection.
CASE SUMMARY: A 70-year-old man underwent TAVR for bicuspid aortic stenosis using a balloon-expandable valve. Moderate to severe PVL was detected 4 months later. A multidisciplinary team evaluated the PVL etiology, patient anatomy, and available treatment options including valve-in-valve and plug closure. A partially fused commissural raphe causing focal underexpansion was identified as the origin of PVL, and late balloon valvuloplasty was performed successfully.
DISCUSSION: Unlike surgical-valve PVL, where percutaneous plug closure is the main treatment option, post-TAVR PVL offers additional approaches. Multimodality imaging helps define mechanism, feasibility, and risk.
TAKE-HOME MESSAGES: Late balloon valvuloplasty is a safe option for underexpanded TAVR in bicuspid valves. Assessment of calcified raphe anatomy and the underexpansion site guides procedural risk and informs treatment selection.