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The 79-year-old male patient had a transcatheter aortic valve replacement (TAVR) placed at another institution in another state, although he presented with more complex issues than only aortic stenosis. The patient was a retired internist who originally had a bicuspid valve with aortic regurgitation (AR) and aortic stenosis (AS). A transcatheter 29 mm valve was placed. However, he was subsequently admitted with acute heart failure due to acute mitral valve regurgitation and anemia. Additionally, he had aortic insufficiency, and the team was concerned about hemolysis.
He underwent a TAVR computed tomography (CT) scan in addition to a transesophageal echocardiogram (TEE) to clarify his diagnosis. The 3Mension program was used to assess the valve, which revealed that there were only two sinuses compatible with a bicuspid valve. The valve was also found to be unusually deep, with more than half of the valve positioned below the annulus at the left coronary cusp (LCC) and too high on the other side. The skirt of the stent was incorrectly placed, resulting in a severe paravalvular leak observed on the scan due to the incorrect placement of the TAVR.
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