Document Type
Conference Proceeding
Publication Date
5-1-2026
Abstract
BACKGROUND - Transcatheter aortic valve replacement (TAVR) is an established therapy for severe aortic stenosis. With improving long-term survival, late prosthetic valve–related complications are increasingly recognized. CASE SUMMARY - We report a 74-year-old man who presented eight years after TAVR with progressive dyspnea, orthopnea, and bilateral lower extremity edema, identified to be acute decompensated heart failure with a new diastolic murmur. Transthoracic echocardiography demonstrated severe aortic regurgitation. Subsequent transesophageal echocardiography identified concomitant severe paravalvular and severe transvalvular regurgitation of the bioprosthetic valve. Invasive hemodynamic assessment revealed acute volume overload with markedly elevated filling pressures, secondary pulmonary hypertension, and right ventricular strain. Given prohibitive surgical risk, the patient underwent simultaneous percutaneous paravalvular leak closure and valve-in-valve TAVR, resulting in resolution of the aortic regurgitation and marked clinical improvement. DISCUSSION - This case highlights a rare manifestation of late TAVR failure and demonstrates the feasibility of a simultaneous percutaneous strategy for mixed-mechanism aortic regurgitation in a high-risk patient. To our knowledge, prior reports have described either paravalvular leak closure or valve-in-valve TAVR performed in isolation for this problem - not simultaneous percutaneous approach. TAKE-HOME MESSAGES - - Concomitant paravalvular and transvalvular regurgitation should be considered in patient presenting with acute heart failure late after TAVR. - A combined percutaneous approach can be feasible and effective in high-risk patients. - Transthoracic echocardiography may underestimate or fail to detect transvalvular regurgitation in the presence of significant paravalvular leak; transesophageal echocardiography is essential for accurate mechanism delineation.
Recommended Citation
Armstrong, A, Halalau L, Hanson I. Severe transvalvular and paravalvular aortic regurgitation as late TAVR failure successfully treated with percutaneous therapy. Presented at: American College of Physicians Michigan Chapter and Society of Hospital Medicine Michigan Chapter 2026 Resident and Medical Student Day; 2026 May 1; Troy, MI. Available from:https://www.acponline.org/sites/default/files/images/about_acp/chapters/mi/2026_MI-ACP_SHM-MI_RMSD_Abstracts_Residents_FINAL.pdf
Comments
American College of Physicians Michigan Chapter and Society of Hospital Medicine Michigan Chapter 2026 Resident and Medical Student Day, May 1, 2026, Troy, MI