A stuck leaflet after balloon post-dilatation in transcatheter aortic valve implantation with a SAPIEN-3 ultra RESILIA valve: a case report

Background Transcatheter aortic valve implantation (TAVI) is a safe and effective therapy for patients with severe aortic stenosis. A Stuck leaflet and severe intraprosthetic regurgitation after valve implantation occur rarely but can lead to sudden haemodynamic deterioration. We encountered a case of a stuck leaflet following post-dilatation with the Edwards Sapien 3 Ultra RESILIA valve.Case summary A 72-year-old woman was referred to our hospital for severe aortic stenosis with shortness of breath. She underwent transfemoral TAVI. After deployment of a 23 mm Sapien 3 Ultra RESILIA valve, post-dilatation was performed due to the presence of paravalvular leak (PVL). Transoesophageal echocardiography revealed a stuck leaflet and severe intraprosthetic regurgitation. Aortography also demonstrated severe aortic regurgitation. We performed valve-in-valve procedure using the second 23 mm valve. Post-valve-in-valve transoesophageal echocardiography showed no PVL nor aortic regurgitation, and haemodynamics improved.Discussion A stuck leaflet is a rare complication following post-dilatation. Severe intraprosthetic regurgitation can lead to sudden haemodynamic changes and may, in some cases, necessitate the use of extracorporeal membrane oxygenation. If haemodynamic changes occur, it is essential to promptly investigate the cause through multiple diagnostic modalities, including transoesophageal echocardiography and angiography.