CTICasesTranscatheter Aortic Valve Implantation (TAVI) Complication: Acute Right Coronary Artery (RCA) Occlusion and Valve Migration
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Imaging findings
A subtle finding on chest radiograph, more conspicuous on subsequent imaging, showed a prosthetic percutaneous aortic valve (TAVI) sitting in the ascending and transverse aorta. During an angiogram for valve placement, there was no filling of the RCA, leading to ventricular fibrillation. The stent with the valve had to be forcibly removed/displaced, and flow was slowly restored to the right coronary artery over an extended procedure.
Key takeaways
This case demonstrates a rarely seen but known complication of TAVI: acute RCA occlusion. Surgeons were unsure if it was caused by covering the RCA ostium or by flicking off plaque from the calcified valve or wall of the intima that then migrated into the RCA ostium. The self-expandable valve was intentionally repositioned to allow work on the coronary artery while the patient was being resuscitated.
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