title: Late Paravalvular Aortic Regurgitation: Migration of the Valve or Late Recoil?
abstract: A 79-year-old man underwent trans-catheter aortic valve replacement for symptomatic severe aortic stenosis with a 26-mm Edwards SAPIEN XT valve. Immediately after valve deployment there was moderate amount of paravalvular leak. Post-dilation was performed with an additional 2 cc of volume, and the paravalvular leak was reduced to trace. Nine months later, trans-thoracic echocardiography revealed moderate to severe paravalvular leak and possible aortic migration of the valve. The patient was brought back for the treatment of the paravalvular leak which was suspected to be due to valve migration. However, fluoroscopy and trans-esophageal echocardiography showed good valve position. Measurement of late valve recoil in the Coplanar view using cine-angiographic analysis software showed that the lower third of the valve had the greatest late recoil (-1.74 mm, 6.55%), which presumably accounted for the progression of the paravalvular leak. Valve-in-valve trans-catheter aortic valve replacement was performed with a 26-mm SAPIEN 3 valve and the paravalvular leak was reduced to trace. This case displays late recoil as a likely mechanism for development of paravalvular leak after SAPIEN XT valve implantation. Our case illustrates that late recoil needs to be systematically evaluated in future studies, especially when trans-catheter aortic valve replacement is being expanded to lower risk and younger patients for whom the longevity and long-term performance of these valves is of critical importance.
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA.
authors.forename: Ashkan
authors.initials: A
authors.lastname: Karimi
authors.affiliation: Division of Nephrology, Hypertension and Renal Transplantation, Department of Medicine, University of Florida, Gainesville, FL, USA.
authors.forename: Negiin
authors.initials: N
authors.lastname: Pourafshar
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA.|North Florida/South Georgia Veterans Health System, Gainesville, FL, USA.
authors.forename: Ki E
authors.initials: KE
authors.lastname: Park
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA.|North Florida/South Georgia Veterans Health System, Gainesville, FL, USA.
authors.forename: Calvin Y
authors.initials: CY
authors.lastname: Choi
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA.
authors.forename: Kiran
authors.initials: K
authors.lastname: Mogali
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, FL, USA.|North Florida/South Georgia Veterans Health System, Gainesville, FL, USA.
authors.forename: Wade W
authors.initials: WW
authors.lastname: Stinson
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, FL, USA.|North Florida/South Georgia Veterans Health System, Gainesville, FL, USA.
authors.forename: Eddie W
authors.initials: EW
authors.lastname: Manning
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA. anthony.bavry@va.gov.|North Florida/South Georgia Veterans Health System, Gainesville, FL, USA. anthony.bavry@va.gov.
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Bavry
keywords: Aortic regurgitation; Trans-catheter aortic valve replacement; Valve-in-valve