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Delayed aortic regurgitation after TEVAR procedure: a case report

Background: Acute aortic regurgitation (AR) is uncommon condition and usually results in an emergent situation because the left ventricle does not adapt quickly due to a sudden increase in end-diastolic volume caused by the regurgitant flow. Thoracic endovascular aortic repair (TEVAR) is a procedure that places a stent-graft on the lesion of thoracic aorta through a minimally invasive approach.

Case presentation: Here we report that a catheter-induced aortic valve injury associated with TEVAR can cause delayed AR, exemplified by the case of a patient who developed acute AR 42 months after TEVAR. For this, aortic valve replacement was performed and the patient was discharged without complications.

Conclusion: Our results demonstrate that when a catheter-related procedure is performed around the aortic valve, slight injury of the valve can cause aortic insufficiency even 3 years after surgery. Consequently, when performing a catheter-related procedure around the aortic valve, special attention is always required.

Comments：

Acute aortic regurgitation is a serious condition that can lead to hemodynamic instability and potentially life-threatening complications. The prompt diagnosis and treatment are crucial to improve the patient's outcome. TEVAR is a minimally invasive approach for the treatment of thoracic aortic aneurysms and dissections. Although it has demonstrated favorable outcomes, it is not without potential complications, such as catheter-induced aortic valve injury, which can lead to aortic regurgitation.

Your case illustrates that even a slight injury to the aortic valve during a catheter-related procedure can lead to delayed aortic insufficiency years after surgery. This finding underscores the importance of careful attention and technique when performing catheter-related procedures around the aortic valve.

In the management of acute aortic regurgitation associated with TEVAR, aortic valve replacement is a viable option, as you have done in your case. Close monitoring and follow-up are also essential to detect potential complications early and intervene promptly.

In summary, this case report highlights the importance of caution and careful technique when performing catheter-related procedures around the aortic valve, as even slight injury can lead to delayed aortic regurgitation. Vigilance in the postoperative period is crucial to detect complications early and ensure optimal patient outcomes.

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