Cardiac arrest caused by coronary occlusion during transcatheter aortic valve implantation: a unique cause

Author:

Gao Xin1,Chen Feifei1ORCID,Jiang Xiaoxiao2,Chen Na3,Liu Jinqiu1,Luan Yong4,Yang Guang5,Yin Da1,Guo Ran1

Affiliation:

1. Department of Cardiology The First Affiliated Hospital of Dalian Medical University Dalian China

2. Department of Cardiovascular Surgery The First Affiliated Hospital of Dalian Medical University Dalian China

3. Department of Cardiovascular Ultrasound The First Affiliated Hospital of Dalian Medical University Dalian China

4. Department of Anesthesiology The First Affiliated Hospital of Dalian Medical University Dalian China

5. Department of Cardiac Intensive Care Unit The First Affiliated Hospital of Dalian Medical University Dalian China

Abstract

AbstractCoronary artery occlusion (CAO) is a rare but life‐threatening complication of transcatheter aortic valve implantation (TAVI). The mechanism of CAO is the displacement of the native calcified valve leaflet over the coronary ostium. Here, we report on a woman who experienced sudden cardiac arrest and abrupt CAO during TAVI, which was caused by two different original obstructions, a rupture of aortic plaque or a partial tear of the aortic intima blocking the upper 2/3 of the left main trunk (LMT) ostium, and the transcatheter heart valve (THV) blocking the lower 1/3 of the LMT ostium. She was eventually successfully treated with the chimney stenting technique. Aortography other than coronary angiography was used to ascertain CAO. In patients presenting with abrupt cardiac arrest or cardiogenic shock with LMT occlusion, there must be prompt identification, and the causes of CAO may be various and rare. The identification of CAO relies not only on CAG but also on aortography, especially if the locations and origins of obstructions are special. Supportive therapy with an attempt at percutaneous revascularization is necessary. Pre‐procedural assessment is crucial prior to TAVI interventions. In cases with high risk of CAO, upfront coronary artery protection can be provided.

Funder

National Natural Science Foundation of China

Publisher

Wiley

Subject

Cardiology and Cardiovascular Medicine

Reference12 articles.

1. Predictive Factors, Management, and Clinical Outcomes of Coronary Obstruction Following Transcatheter Aortic Valve Implantation

2. Chimney Stenting for Coronary Occlusion During TAVR

3. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines;Otto CM;Circulation,2021

4. 2021 ESC/EACTS Guidelines for the management of valvular heart disease

5. Coronary Obstruction Following Transcatheter Aortic Valve Implantation

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