Acute coronary obstruction following transcatheter aortic valve implantation: Small vessels, big problems

Abstract

Transcatheter aortic valve implantation (TAVI) has become in this last decade an alternative treatment to surgery in patients with severe symptomatic aortic stenosis (AS), with a high or prohibitive surgical risk [1]. Despite advances in the development of new devices and the growing experience of centers performing the procedure, the implant is not exempt of risks. Among the potential complications, acute coronary obstruction (CO) represents a rare complication (b1%), but with a high morbidity and mortality [2]. In the majority of the reported cases, the main mechanism of the obstruction is a displacement of the calcified native valve leaflets over the main coronary ostia. The left coronary artery ostium is more frequently affected (~88%) due to its anatomical arrangement [2–3]. Given the significant quantity of ischemic myocardium caused by a left main occlusion, the clinical manifestations are substantial, presented as maintained severe arterial hypotension, electrocardiographic changes (mainly alterations of the ST segment) and/or malignant ventricular arrhythmias [2–4]. However, we are reporting two cases of acute CO following TAVI that, despite occurring