Ingrowths of a Percutaneously Implanted Aortic Valve Prosthesis (CoreValve) in a Patient With Severe Aortic Stenosis

An 80-year-old woman was admitted to our institution because of shortness of breath (New York Heart Association grade III) and stable angina pectoris (Canadian Cardiovascular Society [CCS] grade II).Two years ago, the patient had a posterior wall infarction successfully treated by percutaneous coronary intervention and stent implantation. A low-gradient aortic stenosis with an aortic valve area of 1.1 cm2 was also diagnosed but was considered to be clinically insignificant at the time.Because of the progression of symptoms within the last 2 years, a re-evaluation of coronary and aortic valve disease was performed. Coronary angiography revealed a 1-vessel coronary disease with a patent stent in the right coronary artery without any evidence of restenosis. The left ventricular ejection fraction was only moderately impaired (55%). However, the aortic valve area, as determined invasively, had decreased to 0.5 cm2. This was confirmed by echocardiography; the cusps of the aortic valve were calcified and their motion was impaired (Supplemental Data Movie 1).On the basis of these findings, the necessity of an aortic valve replacement was discussed. However, because the patient was anxious and refused conventional aortic valve …