Structural Valve Deterioration 4 Years After Transcatheter Aortic Valve Replacement

Transcatheter aortic valve replacement (TAVR) has been developed as an alternative treatment modality for those patients with severe symptomatic aortic valve stenosis in whom the risk for conventional surgical aortic valve replacement (AVR) is considered too high or prohibitive.1 However, knowledge regarding longer-term valve durability, especially in younger patients, is very limited. Herein, we report on a 48-year-old female patient presenting with structural valve deterioration 4 years after rescue percutaneous TAVR with a CoreValve bioprosthesis (Medtronic Inc, Minneapolis, Minn). We show the imaging features as well as the macro- and microscopic findings of a deteriorated transcatheter heart valve.In 2010, our then 44-year-old female patient was admitted to the hospital because of rapidly progressive decompensated heart failure. She presented in a markedly reduced general health condition with severe dyspnoe (New York Heart Association class IV), pronounced pulmonary congestion, and bilateral leg edema. Medical history revealed pulmonary embolism in October 2009. At the age of 10 she had undergone previous cardiac surgery for correcting postductal aortic isthmus stenosis. Clinical chemistry showed elevated liver enzymes and signs of beginning renal failure. NT-proBNP was 16.000 ng/L (reference level, <170 ng/L). Echocardiography (iE33, Philips Healthcare, Hamburg, Germany) revealed a stenotic bicuspid valve with bulky calcifications (effective orifice area 0.5cm2, maximum systolic pressure gradient 81 mm Hg, mean pressure gradient 42 mm Hg), concomitant mild regurgitation, and severe left ventricular dysfunction (left ventricular ejection fraction 30%). Additionally, moderate tricuspid regurgitation and reduced right ventricular function was detected. Doppler analysis of tricuspid regurgitant velocity spectrum revealed an estimated systolic pulmonary artery pressure of 70 mm Hg. Because operative risk was considered too …