Spectral CT Imaging of Prosthetic Valve Embolization after Transcatheter Aortic Valve Implantation

Transcatheter heart valve (THV) embolization is a rare complication of transcatheter aortic valve implantation (TAVI) generally caused by malpositioning, sizing inaccuracies and pacing failures. The consequences are related to the site of embolization, ranging from a silent clinical picture when the device is stably anchored in the descending aorta to potentially fatal outcomes (e.g., obstruction of flow to vital organs, aortic dissection, thrombosis, etc.). Here, we present the case of a 65-year-old severely obese woman affected by severe aortic valve stenosis who underwent TAVI complicated by embolization of the device. The patient underwent spectral CT angiography that allowed for improved image quality by means of virtual monoenergetic reconstructions, permitting optimal pre-procedural planning. She was successfully re-treated with implantation of a second prosthetic valve a few weeks later.

Automated summary

Transcatheter heart valve (THV) embolization is a rare complication of transcatheter aortic valve implantation (TAVI), and it is caused by malpositioning, sizing inaccuracies, and pacing failures. The consequences of embolization vary depending on the site, ranging from asymptomatic when the device is stable in the descending aorta to potentially fatal outcomes such as obstruction of vital organ flow, aortic dissection, and thrombosis. In this case, a severely obese 65-year-old woman with severe aortic valve stenosis underwent TAVI complicated by device embolization. Spectral CT angiography with virtual monoenergetic reconstructions was performed for improved image quality and optimal pre-procedural planning. The patient was successfully re-treated with a second prosthetic valve implantation a few weeks later.