Severe paravalvular leakage caused by delayed dislocation of valve prosthesis after transcatheter aortic valve replacement for rheumatic aortic valve disease: A case report.
Delayed left ventricular dislocation of a valve prosthesis causing severe perivalvular leakage after TAVR for rheumatic aortic valve disease was successfully managed with emergency 'valve-in-valve' transcatheter reimplantation, resulting in only mild PVL postoperatively.
Key Findings
Background
A 50-year-old male patient with rheumatic valvular heart disease developed severe perivalvular leakage (PVL) due to delayed left ventricular dislocation of the valve prosthesis following TAVR.
Patient presented with chest tightness and was diagnosed with rheumatic valvular heart disease, aortic stenosis, and severe acute insufficiency
Patient had acute decompensated heart failure with cardiac function grade IV (New York Heart Association) and multiple organ failure at admission
Valve dislocation occurred in a delayed fashion after the initial TAVR procedure, rather than immediately post-implantation
The dislocation resulted in severe PVL and severe heart failure
Results
Emergency 'valve-in-valve' transcatheter reimplantation successfully treated the severe PVL caused by delayed prosthesis dislocation.
A second emergency TAVR operation was performed after the delayed dislocation and severe PVL were identified
The TAVR artificial valve was reimplanted using the transcatheter 'valve-in-valve' technique
Postoperative evaluation showed reduction of PVL from severe to mild
Clinical symptoms were relieved following the second procedure
Conclusions
Severe PVL caused by delayed dislocation of valve prosthesis after TAVR in the setting of rheumatic aortic valve disease and multiple organ failure is a rare but serious complication.
The case is described as 'rare' in the context of TAVR complications
Rheumatic aortic valve disease was identified as a relevant underlying condition potentially contributing to the complication
The presence of multiple organ failure added to the complexity of management
The authors note this complication 'might necessitate prosthetic valve reimplantation using the transcatheter valve-in-valve technique'
What This Means
This case report describes a 50-year-old man with severe heart valve disease caused by rheumatic fever who underwent a minimally invasive procedure called transcatheter aortic valve replacement (TAVR), in which a new valve is inserted through a catheter without open-heart surgery. After the initial procedure, the newly placed artificial valve shifted out of its correct position — a complication that developed with a delay rather than immediately after surgery. This caused a serious leakage of blood around the outside of the artificial valve (called perivalvular leakage), which worsened his already critical heart failure.
To address this life-threatening situation, the medical team performed an emergency second TAVR procedure using a 'valve-in-valve' technique, meaning a new artificial valve was inserted inside the first displaced one to restore proper function. After this second procedure, the leakage was reduced from severe to mild, and the patient's symptoms improved.
This research suggests that delayed displacement of a TAVR prosthetic valve leading to severe leakage, while rare, can occur even in high-risk patients with rheumatic valve disease and multi-organ failure, and that the 'valve-in-valve' transcatheter approach may be a viable emergency treatment option in such cases without requiring open-heart surgery.
Xu C, Guo H, Su X. (2026). Severe paravalvular leakage caused by delayed dislocation of valve prosthesis after transcatheter aortic valve replacement for rheumatic aortic valve disease: A case report.. Medicine. https://doi.org/10.1097/MD.0000000000049867