Shock after immediate TAVI implantation. Do we know what we are dealing with?

Abstract

CASE PRESENTATION Eighty-four-year-old woman with hypertension, dyslipidemia, a past medical history of bronchial asthma, stroke in the left middle cerebral artery territory without negative side effects, and moderate chronic kidney disease (glomerular filtration rate, 42 mL/min/1.73 m2 according to the Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI] equation). Also, the patient has a past medical history of non-ST-segment elevation acute myocardial infarction with revascularization of the left circumflex artery proximal segment with a conventional stent back in 2006 without an impaired ventricular function. The patient also showed moderate aortic stenosis for which she was regularly monitored by her cardiologist with a rate of progression of valvular heart disease in ranges of severity (peak gradient, 110 mmHg; mean gradient, 74 mmHg; continuity equation valve area, 0.75 cm2 and indexed, 0.45 cm2/m2) with preserved ventricular function (left ventricular ejection fraction of 67% measured using Simpson’s method). The echocardiography (figure 1) revealed the presence of left ventricular hypertrophy (a 19 mm interventricular septum and a 13 mm posterior wall) and a reduced ventricular cavity (a 38 mm end-diastolic diameter).