Silent coronary obstruction following transcatheter aortic valve implantation: Detection by transesophageal echocardiography

Abstract In several recent guidelines, transcatheter aortic valve implantation (TAVI) has been recommended as a therapeutic option for inoperable or high surgical risk patients with severe aortic stenosis. TAVI has various specific complications that seldom occur in surgical aortic valve replacement. Among them, coronary obstruction (CO) is an infrequent but serious complication. Previous case series have reported symptomatic CO cases diagnosed by hemodynamic instability, electrocardiographic changes, and abnormal findings on aortography. We report a case of silent CO in an 86-year-old female. Monitoring of coronary flow by transesophageal echocardiography led to a diagnosis of CO. Silent CO is probably an underdiagnosed complication of TAVI. Learning objective: Coronary obstruction is an infrequent but serious complication of transcatheter aortic valve implantation (TAVI). Previous case series have reported only symptomatic coronary obstruction cases diagnosed by hemodynamic instability, electrocardiographic changes, and abnormal findings on aortography. Transesophageal echocardiography monitoring of coronary ostium flow is useful for detecting coronary obstruction. Silent coronary obstruction is probably an underdiagnosed complication of TAVI.>