Fernanda M. Mangione et al. JIMG 2017;10:82-85

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Fernanda M. Mangione et al. JIMG 2017;10:82-85 Early Leaflet Thrombosis Related to Asymmetry and Underexpansion of the TAVR A 75-year-old woman underwent transfemoral TAVR immediately complicated by a left bundle branch block. The patient was discharged 3 days later on aspirin and clopidogrel. One day after discharge, she was admitted with chest pressure, pulmonary edema, and new-onset atrial fibrillation. Transthoracic echocardiography showed diffuse thickening of the transcatheter valve (A, arrow) (Online Video 3), but no increase in the mean pressure gradient (10 mm Hg [B]) and severe decrease in left ventricle ejection fraction (from 50% to 30%) with new anterior and septal segmental dysfunction. Her hospital course was complicated by hemodynamic instability, and she expired after 24 h of hospitalization. Autopsy findings showed low implantation of the Edwards Sapien 3 valve, impinging on the basal surface of the myocardium and compressing the AV node (C). The valve showed asymmetry due to incomplete expansion and presence of thrombus on the valve leaflets (D and E). There was multifocal acute ischemic damage to cardiomyocytes. AV = atrioventricular; TAVR = transcatheter aortic valve replacement. Fernanda M. Mangione et al. JIMG 2017;10:82-85 American College of Cardiology Foundation