First Case Report of a Severe Stent Frame Infolding of a Self-Expanding Transcatheter Aortic Valve (CoreValve Evolut R 34 mm) in a Complex Patient With Calcific Bicuspid Aortic Valve Stenosis

Abstract

• Infolding of the self-expanded nitinol valve is a rare complication and is likely to be related to several contributing factors (e.g. improper valve loading). This type of complication has been also reported with self-expanding nitinol endovascular stent grafts for treatment of abdominal and thoracic aorta aneurysms. • Recognizing infolding before the complete release of the valve allows to prevent extreme hemodynamic instability, that can be fatal. • The guidewire in the correct position in left ventricle should never be withdrawn or lost. So that the malfunctioning infolded valve can be corrected by post-dilation. • To our knowledge, this is the first case of valve infolding in a patient with Bicuspid Aortic Valve (BAV) stenosis early recognized by rotational fluoroscopy.