During transcathether aortic valve replacement (TAVR) procedures, the mitral apparatus may suffer serious, potentially lethal impairment, according to a new case study describes an approach to address the problem through percutaneous management.

The study was published online Aug. 21 in The Journal of the American College of Cardiology.

“The mitral valve is vulnerable and could be badly impaired in transcatheter aortic valve replacement patients,” wrote lead author Asma Bourezg, the intensive cardiac care department at the Hospices Civil de Lyon, in Lyon, France, and colleagues. “Albeit rare, mitral perforation is a complication that physicians should be aware of because percutaneous management may be lifesaving.”

The patient was a New York Heart Association functional class III symptomatic 90-year old male with severe aortic stenosis. He underwent femoral access TAVR, which had seemed to go smoothly.

However, one hour post operatively, the man experienced intractable cardiogenic shock with intense holosystolic murmur. To determine the cause of his setbacks, the team used transesophageal echocardiography which allowed them to identify a massive mitral regurgitation by perforation of the mitral-aortic curtain.

The team performed a rescue percutaneous repair which served to dramatically decrease the mitral regurgitation.  The patient’s hemodynamics quickly recovered. Six hours after the procedure ended, inotropic support and assisted ventilation could both be stopped.

Discharge took place five days after the procedure. Although the patient experienced mild anemia during the first six months, episodic blood transfusion resolved the problem. Two years post-operatively, the patient was in good condition, without aortic or mitral valve abnormalities.