Right coronary occlusion following transcatheter aortic valve implantation: two case reports

Abstract

This paper discusses two male patients with severe aortic stenosis, whose right coronary arteries (RCA) were completely occluded during transcatheter aortic valve implantation (TAVI), leading to fatal hemodynamic disorder. Occlusions of RCA complicated by TAVI are rare. In addition, emergency cardiopulmonary bypass (CPB) played a critical role in rescuing our second patient. Both patients were admitted for “severe aortic stenosis,” and TAVIs were performed. The first patient’s blood pressure immediately dropped to 70/40 mmHg after the balloon expansion and did not increase much after the administration of aramine or fluid therapy. He did not receive emergency surgery and died after 1.5 h of resuscitation. The second patient’s blood pressure fluctuated greatly for several minutes after the valve implantation, ranging from 170/100 mmHg to 60/40 mmHg. Angiography revealed a total occlusion of RCA. Thoracic surgery with CPB was performed, and the patient survived.

Keywords

aortic stenosis / transcatheter aortic valve implantation / right coronary occlusion / cardiac group

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Acknowledgements

We thank the patients and their families for the permission to share with the readers their diagnosis and treatment of severe complication of TAVI. We thank Dr. Yu Zhang for the help in the collection of medical data.

Compliance with ethics guidelines

Gang Zhang, Jun Luo, and Guo Chen declare that they have no conflicts of interest. Informed consent was obtained from the patients for inclusion in this study.

RIGHTS & PERMISSIONS

2016 Higher Education Press and Springer-Verlag Berlin Heidelberg