Successful TAVI Despite Sudden Low Output and Ventricular Fibrillation in a Patient with Cardiac Amyloidosis

Abstract

Management of patients with cardiac amyloidosis and concomitant high-grade aortic stenosis is challenging. Here, we report the case of a 79-year-old man with transcatheter aortic valve implantation (TAVI) complicated by low cardiac output during release of a Medtronic Evolut R 34 mm valve. After initiation of mechanical circulatory support, the TAVI valve was successfully implanted despite ongoing ventricular fibrillation. The ventricular fibrillation was successfully treated with injection of potassium into the aorta, with subsequent defibrillation and ventricular pacing. Moreover, pharmacological management of transient severe LV dysfunction and high-grade mitral regurgitation finally led to a favourable course.