Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 26, 2020; 8(4): 815-819
Published online Feb 26, 2020. doi: 10.12998/wjcc.v8.i4.815
Delayed right coronary ostial obstruction after J-valve deployment in transcatheter aortic valve implantation: A case report
Zhao Xu, Hong Yu, Peng Liang
Zhao Xu, Hong Yu, Peng Liang, Department of Anesthesiology, West China Hospital, Sichuan University and The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu 610041, Sichuan Province, China
Author contributions: Xu Z and Yu H gathered medical records of the patient; Xu Z, Yu H and Peng L wrote the paper.
Supported by the National Natural Science Foundation of China, No. 81600918.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Peng Liang, MD, Associate Professor, Department of Anesthesiology, West China Hospital, Sichuan University and The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, No. 37 Guoxue Alley, Chengdu 610041, Sichuan Province, China. 39485572@qq.com
Received: November 1, 2019
Peer-review started: November 1, 2019
First decision: December 4, 2019
Revised: December 23, 2019
Accepted: January 1, 2020
Article in press: January 15, 2020
Published online: February 26, 2020
Processing time: 116 Days and 23.2 Hours
Abstract
BACKGROUND

Aortic stenosis is the most common valve disease in adults. Transcatheter aortic valve implantation (TAVI) is being increasingly applied for intermediate- to low-risk patients. Here, we describe an uncommon complication of delayed right coronary obstruction in a transapical TAVI case.

CASE SUMMARY

A 73-year-old woman with a EuroSCORE II of 1.21% underwent transapical TAVI because of severe aortic stenosis. The surgical procedure was uneventful. However, during routine monitoring after valve placement, the patient had a sudden onset of slow heart rate, the systolic blood pressure dropped sharply from 115 to 60 mmHg, and the central venous pressure abruptly increased from 10 to 33 cmH2O. The patient had a poor response to vasoactive agents. Transesophageal echocardiography revealed poor myocardial contractility, and electrocardiography showed a significant depression of ST-segment. Another angiography was performed immediately, which suggested complete obstruction of the right coronary artery. An emergency protocol was initiated. Cardiopulmonary bypass was established immediately. An aortic biological valve replacement under cardiopulmonary bypass was performed.

CONCLUSION

Perioperative monitoring, early recognition, and diagnosis of obstruction of coronary arteries in TAVI are important. Transesophageal echocardiography is a useful diagnostic and monitoring tool in this situation. Emergency protocols should be established during TAVI.

Keywords: Transcatheter aortic valve implantation; Right coronary artery; Obstruction; Complication; Management; Case report

Core tip: Right coronary artery obstruction during transcatheter aortic valve implantation (TAVI) is relatively rare. The unique pathophysiological findings of this case were thoroughly described. Prompt recognition by anesthesiologists of this complication during TAVI is particularly important. Heart team approach has been proven to be effective and efficient in emergencies during TAVI. Sufficient knowledge about the procedure is required by the whole team. A comprehensive preoperative evaluation should be performed and emergency protocols should be established in advance so that prompt and right decisions can be made and ensure timely resuscitation of the patients.