Transcatheter Aortic Valve Implantation (core valve) prosthesis complicated by mitral stenosis

A 90 year-old male patient, known to have severe aortic stenosis (AS), was admitted with chest pain, shortness of breath and swelling of both lower limbs. He had history of ischemic heart disease and percutaneous coronary intervention (PCI) of left anterior descending artery (LAD) in 2002. He also had long standing hypertension, primary hypothyroidism and hypercalcemia. He had a permanent pacemaker, chronic gastritis, gastrointestinal bleeding and bilateral knee osteoarthritis in 2007. Patient was treated medically for his heart failure symptoms. Transthoracic echocardiogram (TTE) showed normal ejection fraction 55% and severe aortic stenosis, aortic valve area 0.58 cm², mean G 64 mmHg and peak gradient of 118 mm Hg. In November 2010 the patient was evaluated for the transcatheter aortic valve implantation (TAVI) program after a multidisciplinary evaluation. His predicted Euro Score was 28% and both risk and benefits were explained to the family. A 29 mm core valve prosthesis was deployed. The TTE 4 days later showed mitral valve (MV) area = 2.04 cm² and MG across MV = 6 mm Hg. Impingement of anterior mitral valve leaflet (AMVL) by the inflow portion of core valve prosthesis led to mild mitral stenosis (MS). TEE is a helpful tool to diagnose this phenomenon.