History: In an 85-year-old woman with severe symptomatic aortic stenosis transcatheter aortic valve implantation (TAVI) was performed via a transfemoral access. A 26 mm Sapien Edwards XTTM prosthesis was implanted.
Findings: Shortly after the implantation arterial blood pressure began to drop. Aortic root angiography demonstrated occlusion of the left main stem and the small right coronary artery.
Treatment: Mechanical resuscitation had to be started, while a 6 French guiding catheter was inserted. A guide wire could be inserted into the left main stem, which resulted in slow antegrade flow (TIMI grade II), with an almost immediate rise in the arterial pressure. Implantation of a bare metal stent into the ostium of the left main stem resulted in a normal flow to the left coronary artery and arterial blood pressure returned to normal.
Course: Further clinical course was uneventful and the patient could be discharged one week later. Sixteen months after the procedure, she is still well.
Conclusion: TAVI should be performed by experienced staff with a cardiac surgery unit in stand-by; the compartment should be equipped with all facilities of an interventional catheterization laboratory.
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