title: Aortic Regurgitation after TAVR: From Bad to Worse.
abstract: Transcatheter aortic valve replacement (TAVR) is a valuable alternative in surgical high-risk patients with symptomatic aortic valve stenosis. Here, the case is presented of very early transcatheter heart valve degeneration, probably caused by a 'Venturi effect' of a severe paravalvular regurgitant jet. This ultimately led to a leaflet being in the open position, creating severe valvular regurgitation that necessitated classical surgical revision. The occurrence of paravalvular regurgitation, and its known relationship with an adverse prognosis after TAVR, demonstrates the clear need for innovative alterations in valve design to prevent this complication. Video 1: Angiography immediately after implantation of an Edwards SAPIEN 23 mm transcatheter heart valve, showing severe paravalvular aortic valve regurgitation. The implantation position is rather low. Video 2: Transesophageal echocardiography with 2-D color imaging showing aortic valve long-axis view at 131°, three days after implantation of an Edwards SAPIEN 23 mm transcatheter heart valve. Severe eccentric paravalvular aortic valve regurgitation is shown without a significant valvular component. The implantation position is rather low. Video 3: Transesophageal echocardiography with 2-D color imaging showing aortic valve long-axis view at 120°, one month after implantation of an Edwards SAPIEN 23 mm transcatheter heart valve. Severe combined valvular and paravalvular aortic valve regurgitation (grade 4/4) is shown.
authors.affiliation: Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven.
authors.forename: Nick
authors.initials: N
authors.lastname: Hiltrop
authors.affiliation: Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven.|Department of Cardiovascular Sciences, KU Leuven, Leuven.
authors.forename: Tom
authors.initials: T
authors.lastname: Adriaenssens
authors.affiliation: Department of Cardiovascular Sciences, KU Leuven, Leuven.|Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Paul
authors.initials: P
authors.lastname: Herijgers
authors.affiliation: Department of Cardiovascular Sciences, KU Leuven, Leuven.
authors.forename: Christophe
authors.initials: C
authors.lastname: Dubois
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000503:physiopathology / Q000601:surgery*; D020878:Device Removal; D018618:Echocardiography, Doppler, Color; D017548:Echocardiography, Transesophageal; D005260:Female; D006350:Heart Valve Prosthesis; D006439:Hemodynamics; D006801:Humans; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects* / Q000295:instrumentation; D016896:Treatment Outcome