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case_images: Images of the patient. (A) Preprocedural findings on contrast-enhanced computed tomography. Aortic annular area and perimeter are 359 mm2 and 69.1 mm, respectively. (B) The implanted 23 mm Sapien3 Ultra Resilia transcatheter heart valve with a 2 mL underfilling volume.
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case_images: Contrast-enhanced computed tomography (CT) angiography revealed that the annular perimeter and area were 69.1 mm and 359 mm2, respectively (Figure 1A). A 23 mm Sapien3 Ultra Resilia transcatheter heart valve (Edwards Lifesciences) was successfully implanted under local anaesthesia (Figure 1B), with an initial aortic DeltaP of 9 mmHg and minimal paravalvular leakage (PVL).
case_images: Changes in transthoracic echocardiography. (A) Predischarge transthoracic echocardiography findings (4 days following transcatheter aortic valve replacement). (B) Transthoracic echocardiography findings at exacerbation (54 days following transcatheter aortic valve replacement). (C) Transthoracic echocardiography findings after improvement (70 days following transcatheter aortic valve replacement).
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case_images: However, predischarge evaluation showed a mean aortic DeltaP of 12 mmHg, with no changes in PVL (Figure 2A). Transthoracic echocardiography revealed no pulmonary hypertension; however, the mean aortic valve DeltaP increased to 54 mmHg, and the aortic valve area decreased to 0.86 cm2 (Figure 2B). Transthoracic echocardiography at 16 days later revealed that the left and non-coronary cusp mobility improved, the mean aortic valve DeltaP improved by 15 mmHg (Figure 2C, Supplementary material online, Video S3), and the subjective symptoms resolved.
case_images: Changes in blood work results.
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case_images: Blood work revealed a markedly elevated haemoglobin level of 13.2 g/dL, a high D-dimer level of 18.1 mug/mL (reference: <1.0 mug/mL) and a decreased platelet count of 4.4 x 104 muL (reference: 160 x 109-360 x 109/L) (Figure 3). Transthoracic echocardiography at 16 days later revealed that the left and non-coronary cusp mobility improved, the mean aortic valve DeltaP improved by 15 mmHg (Figure 2C, Supplementary material online, Video S3), and the subjective symptoms resolved. The D-dimer level was also not elevated at 7.6  mug/mL (Figure 3).