Delayed coronary obstruction of the left main artery after transcatheter aortic valve replacement

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Coronary arteries’ obstruction associated with transcatheter aortic valve implantation (TAVI) may occur either during the procedure or after it. In the latter coronary obstruction can be further divided into early (<7 days after procedure) or delayed one (>7 days). Delayed coronary obstruction (DCO) is referred as a rare but devastating complication after TAVI and is associated with the extremely high mortality. This case demonstrates the objective difficulties of timely diagnostics of DCO. Since the results of non-invasive methods are indetermined in most cases, the authors conclude that even low-specific clinical symptoms must be interpreted as the definite rationale for the implementation of invasive diagnostic and treatment strategy.

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About the authors

A. E. Komlev

National Medical Research Center of Cardiology

Author for correspondence.
ORCID iD: 0000-0001-6908-7472

Russian Federation, Moscow

кардиолог отд. сердечно-сосудистой хирургии

P. M. Lepilin

National Medical Research Center of Cardiology

ORCID iD: 0000-0003-2979-2542

Russian Federation, Moscow

к.м.н., сердечно-сосудистый хирург, ст. науч. сотр. отд. сердечно-сосудистой хирургии

E. V. Kurilina

National Medical Research Center of Cardiology


Russian Federation, Moscow


V. V. Romakina

National Medical Research Center of Cardiology

ORCID iD: 0000-0002-0035-0794

Russian Federation, Moscow

кардиолог отд. сердечно-сосудистой хирургии

T. E. Imaev

National Medical Research Center of Cardiology

ORCID iD: 0000-0002-5736-5698

Russian Federation, Moscow

д.м.н., сердечно-сосудистый хирург, гл. науч. сотр. отд. сердечно-сосудистой хирургии


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Supplementary files

Supplementary Files Action
Fig. 1. ECG of the patient upon admission.

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Fig. 2. Measurement of trans-prosthetic systolic gradients on AK.

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Fig. 3. Preoperative CAG: a - LCA, b - right coronary artery.

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Fig. 4. MSCT aortography.

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Fig. 5. Intraoperative ChpEchoCG: a - the arrow indicates the flotation fragment of the left coronary valve of the AK immediately after balloon valvotomy of the AK; b - functioning bioprosthesis AK; additional formations in the projection of the coronary sinus are not visualized.

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Fig. 6. Control angiography.

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Fig. 7. ECG on the 1st day after the transfer from the intensive care unit.

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Fig. 8. ECG in dynamics (2nd postoperative day).

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Fig. 9. ECG at the time of a sharp deterioration.

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Fig. 10. Self-expanding bioprosthesis in the aortic position. A fragment of the split left coronary cusp of the native AK outlining the mouth of the LCA is outlined in blue.

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