Introduction: T he continuous advance in materials and technique of percutaneous aortic valve implantation has brought about increasingly better results thus allowing greater access to treatment of patients that are not eligible for classic surgery due to high perioperative risk.
Case presentation: 82-year-old patient is admitted for recently worsened NYHA class IV heart failure symp-toms and CCS class II angina pectoris. Echocardio-graphy reveals severe aortic stenosis, moderate mitral regurgitation and a dilated left ventricle. Due to high surgical risk the patient is referred for percutaneo-us aortic valve implantation. Coronary angiography shows normal coronary arteries. During ventriculogra-phy intramyocardial contrast medium extravasation suggestive of intramural hematoma was observed, with no hemodynamic impact. A 23 mm Edwards Sapien 3 valve was implanted with a good result. Progressive drop in hemoglobin to 7.5 mg/dl was observed post-procedurally. A complication at the femoral arterial puncture site was suspected. Doppler echography re-vealed hematoma and pseudo-aneurism, later confir-med by computed tomography. Echo guided local com-pression was performed and blood transfusions were given. 8 days after the procedure the patient develops symptomatic high degree AV block that required per-manent cardiac pacing. The rest of the hospital course was favorable, and the patient was discharged 14 days after the procedure. The patient was asymptomatic, and her hemoglobin levels normalized at subsequent visits.
Case particularity: We present the case of an 82-year-old woman with a frail habitus, referred for TAVI, who in the pre- and post-procedural settings develops mul-tiple complications. A correct and prompt approach of these complications has allowed for swift recovery without a negative impact on her long-term prognosis.
Conclusions: Despite advances in materials and tech-nique of TAVI procedures, possible complications re-main a fearful adversary that require prompt action in order not to negatively impact the long-term outcome of the patient.