Left ventricular papillary muscle rupture due to acute myocardial infarction after transcatheter aortic valve replacement.

Introduction: Mitral regurgitation is a potential complication of transcatheter aortic valve replacement. Here, we report a case of severe acute mitral regurgitation caused by papillary muscle rupture occurring 16 days after transcatheter aortic valve replacement.

Presentation of case: An 82-year-old woman with severe AS was referred to our hospital. Transfemoral transcatheter aortic valve replacement was scheduled. Preoperative computed tomography revealed that the height of the left coronary artery was 8.7 cm, and a self-expandable valve was selected. The procedure was performed successfully without coronary obstruction. A complete atrioventricular block was observed on postoperative day 5, and a pacemaker was implanted. On postoperative day 13, the patient suddenly developed dyspnoea. Coronary angiography revealed stenosis of the left main coronary artery, and percutaneous coronary intervention was successfully performed. However, on postoperative day 16, she again developed sudden dyspnoea. Transoesophageal echocardiography revealed severe mitral regurgitation caused by rupture of the left ventricular papillary muscle. An emergency mitral valve replacement was performed. Her postoperative course was uneventful.

Discussion: Left ventricular papillary muscle rupture due to acute myocardial infarction after transcatheter aortic valve replacement is rare. In case of anatomical risk of coronary artery occlusion after transcatheter aortic valve replacement with a self-expandable valve, careful observation for delayed coronary obstruction should be continuously performed, even when the valve is placed in a low position.

Conclusion: Severe MR due to papillary muscle rupture can be a complication of TAVR. In such cases, emergency mitral valve replacement should be performed.