Acute Occlusion of Right Coronary Artery During Transcatheter Aortic Valve Replacement of a Bicuspid Valve

Background

Coronary artery occlusion following transcatheter aortic valve replacement is a severe complication.

Case Summary

We present a case of coronary artery occlusion that occurred unexpectedly despite thorough preprocedural planning under the anatomically unique condition of a bicuspid aortic valve. Several factors that warrant reconsideration during preprocedural planning became clearer through the case analysis and subsequent autopsy findings.

Discussion

Despite best practice in preprocedural planning, exact simulation of procedural work flow and precise risk assessment remains restricted owing to patient-specific anatomical and functional characteristics not amenable to preprocedural projection.

Take-Home Messages

When transcatheter aortic valve replacement is performed in the setting of a bicuspid aortic valve, coronary artery–related complications may be at increased risk for failed percutaneous bailout procedures. When assessing the risk of coronary artery occlusion in bicuspid aortic valves, it is important to consider not only coronary artery height, but also the distribution of calcification.