case_images: PMC10854999_01
case_images: ECG showing LBBB. ECG, electrocardiogram; LBBB, left bundle branch block
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case_images: PMC10854999_01_cureus-0016-00000052027-i01.jpg
case_images: FIG1
case_images: TAVR was done 16 months before the current presentation, and the patient was on dual antiplatelet therapy with aspirin and clopidogrel after TAVR. The patient experienced typical chest discomfort, along with sweating and elevated blood pressure. The results of an electrocardiogram (ECG) (Figure 1) showed chronic left bundle branch block (LBBB) with nonspecific ST-T-wave changes and a high-sensitivity troponin I (280 ng/L) test consistent with non-ST-segment elevation myocardial infarction (NSTEMI).
case_images: Abrupt occlusion of distal LAD in the angiogram (red arrow). LAD, left anterior descending
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case_images: PMC10854999_01_cureus-0016-00000052027-i02.jpg
case_images: FIG2
case_images: However, the distal LAD exhibited an abrupt obstruction, concerning an embolic event or plaque rupture (Figure 2).
case_images: Cardiac CT highlighting HALT in short and long axes. CT, computed tomography; HALT, hypoattenuated leaflet thickening
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case_images: PMC10854999_01_cureus-0016-00000052027-i03.jpg
case_images: FIG3
case_images: A subsequent cardiac CT revealed hypoattenuation opacity at the base of the aortic valve leaflets (HALT), confirming our suspicion (Figure 3).
case_images: Repeat cardiac CT after three months showing resolution of HALT in short and long axes . CT, computed tomography; HALT, hypoattenuated leaflet thickening
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case_images: PMC10854999_01_cureus-0016-00000052027-i04.jpg
case_images: FIG4
case_images: On a follow-up visit, a repeat cardiac CT showed a resolution of HALT after three months (Figure 4).