Prosthesis-to-Prosthesis Balloon Interaction During TAVR Causing Aorto-Mitral Curtain Injury and Left Ventricular Pseudoaneurysm.

BACKGROUND: Transcatheter aortic valve replacement (TAVR) in patients with previous mitral valve replacement presents unique procedural challenges because of altered left ventricular outflow tract anatomy and potential prosthesis-to-prosthesis interaction. CASE SUMMARY: An 82-year-old woman with a 27-mm Medtronic Mosaic bioprosthetic mitral valve replacement underwent balloon-expandable valve TAVR for severe symptomatic aortic stenosis complicated by aorto-mitral curtain injury and a contained left ventricular pseudoaneurysm. Balloon interaction with the protruding mitral bioprosthesis likely caused the injury. Shortly after discharge, she presented with worsening dyspnea and back pain, and multimodality imaging demonstrated a contained pseudoaneurysm adjacent to the mitral prosthesis. Conservative management was pursued because of prohibitive surgical risk and hemodynamic stability, with close clinical and imaging surveillance. DISCUSSION: This case highlights prosthesis-to-prosthesis interaction as a potential mechanism of aorto-mitral curtain injury during TAVR. TAKE-HOME MESSAGES: Aorto-mitral curtain injury after TAVR may present subacutely and require prompt multimodality imaging. Conservative management may be reasonable in selected hemodynamically stable patients.