Introduction Transcatheter aortic valve implantation is currently considered an alternative treatment
for older patients with severe aortic valve stenosis and increased surgical risk, but can be associated with
multiple life-threatening complications.
Case outline An 83-year-old woman with severe symptomatic aortic stenosis, body weight of 29 kg and
body surface area of 1.1 m2
underwent transcatheter aortic valve implantation via transapical access.
Severe hypotension occurred before the valve implantation, due to temporary distortion of the mitral
valve apparatus by stiff wire, leading to acute mitral regurgitation. This complication was immediately
recognized by continuous transesophageal echocardiography and managed by simple wire retrieval
instead of applying mechanical circulatory support. After rewiring and predilatation of the stenotic aortic
valve, a 23 mm balloon-expandable transcatheter stent-prosthetic valve was successfully implanted.
Conclusion This case demonstrates that continuous imaging during transcatheter aortic valve implantation is key to rapid diagnosis of life-threatening complications, associated with the procedure, especially
during the early learning curve in transapical approach.
