Acute pulmonary hemorrhage after dislocation of transcatheter aortic valve prosthesis

Transcatheter aortic valve implantation (TAVI) has been increasingly used as a preferred treatment for severe symptomatic aortic stenosis in inoperable and high surgical risk patients. The choice between the surgical or TAVI approach is made based on estimated surgical risk and comorbidities of the individual patient [1]. Contemporary imaging techniques and advances in valve technology resulted in a decrease of complications and improved overall outcomes. The role of TAVI is expanding – newer indications for its use are under research [2]. There is growing interest in the application of TAVI in lower surgical risk patients or in patients with anatomical difficulties [3]. Recent reports confirm the trend of transcatheter valve replacement in patients who are at low or intermediate risk [4]. The conventional surgical approach is not superior to TAVI in intermediate risk patients. Moreover, less invasive procedures result in lower risk of major postoperative complications and more rapid early recovery, which result in shorter durations of stay in the intensive care unit (ICU) and hospital. We present a case of unsuccessful TAVI complicated with acute severe bronchial bleeding in a patient with aortic coarctation.
A 73-year-old woman with worsening shortness of breath (New York Heart Association class III) due to aortic valve lesions was referred for aortic valve replacement. Prior to admission she underwent interposition graft replacement for aortic coarctation in her childhood. Baseline transthoracic echocardiography reported a calcified aortic valve with an aortic valve area of 0.7 cm², mean pressure gradient of 40.9 mm Hg alongside moderately impaired left ventricular ejection fraction of 30% and moderate pulmonary hypertension.
Multislice computed tomography (MSCT) and cardiac catheterization angiography revealed normal coronary arteries; diameters of the aortic annulus and ascending aorta at the sinotubular junction were 25 and 33 mm, respectively. Images demonstrated postcoarctation repair appearance of the aortic arch with the diameter of 25 mm and evidence of re-coarctation narrowing and kinking in the proximal descending aorta up to 20 mm. Diameter of the descending aorta of was 26 mm with normal appearance of suprarenal and infrarenal segments.
Patients’ logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE II) was 5.78% and Society of Thoracic Surgeons (STS)-predicted mortality was 2.3%. The...


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