title: Aortic valve cusp shearing and migration into the left main coronary artery during transcatheter aortic valve implantation.
abstract: In inoperable or high-risk patients with severe aortic stenosis, transcatheter aortic valve implantation (TAVI) provides an efficacious and safe alternative to surgical aortic valve replacement. In this case report, TAVI resulted in aortic valve cusp shearing and migration into the left main coronary artery, resulting in occlusion of coronary blood flow and cardiac arrest. The patient underwent immediate cardiopulmonary support and surgical intervention with a favourable outcome. With this case report, we illustrate the etiology and management of this complication, which can be recognized nonsurgically only if a high index of suspicion exists.
authors.affiliation: Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Hadi Daood
authors.initials: HD
authors.lastname: Toeg
authors.forename: Marino
authors.initials: M
authors.lastname: Labinaz
authors.forename: Chris
authors.initials: C
authors.lastname: Hudson
authors.forename: Marc
authors.initials: M
authors.lastname: Ruel
mesh_terms: D000369:Aged, 80 and over; D001021:Aortic Valve / Q000293:injuries*; D001024:Aortic Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods; D016887:Cardiopulmonary Resuscitation; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D015150:Echocardiography, Doppler; D005500:Follow-Up Studies; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006323:Heart Arrest / Q000209:etiology / Q000628:therapy*; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008297:Male; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome