Continuous Assessment of Left Ventricular Outflow Obstruction in Transcatheter Aortic Valve Implantation.

BACKGROUND

Left ventricular outflow tract (LVOT) obstruction is a rare but fatal complication after transcatheter aortic valve implantation (TAVI). Early detection and timely intervention are essential for favorable clinical outcomes.

CASE SUMMARY: We report a case of LVOT obstruction diagnosed and dynamically monitored via a SavvyWire (Haemonetics). A 78-year-old woman underwent transfemoral TAVI for severe valve stenosis, and continuous hemodynamic monitoring by the SavvyWire identified a significant aorto-left ventricular pressure gradient with systemic hypotension immediately after valve deployment, indicating LVOT obstruction. Prompt administration of intravenous fluids and vasopressors resulted in rapid hemodynamic stabilization.

DISCUSSION: This case underscores the utility of the SavvyWire for immediate detection and management of dynamic LVOT obstruction, potentially improving safety profiles in TAVI procedures.

TAKE-HOME MESSAGE: Continuous monitoring of the aorto-left ventricular pressure gradient can facilitate early diagnosis of LVOT obstruction in TAVI procedures.