From Paravalvular Leak to Transvalvular Regurgitation: A Case of Persistent Symptoms After Transcatheter Aortic Valve Implantation Requiring Redo Transcatheter Aortic Valve Implantation

Transcatheter aortic valve implantation (TAVI) is a cornerstone treatment for severe aortic stenosis; however, complications such as paravalvular leak (PVL), hypoattenuated leaflet thickening (HALT), and hypoattenuation affecting motion (HAM) can lead to persistent symptoms requiring reintervention. We report the case of a 70-year-old man with symptomatic severe aortic stenosis who underwent TAVI with a 27.5-mm Myval™ transcatheter heart valve (Meril Life Sciences, Vapi, Gujarat, India). Post-procedure, moderate PVL was identified, followed by persistent dyspnea at three months. Multimodal imaging, including transthoracic echocardiography, transesophageal echocardiography, and computed tomography, revealed HALT, HAM, and moderate-to-severe transvalvular leakage (TVL). Despite balloon post-dilation and anticoagulation therapy, symptoms persisted, necessitating a valve-in-valve redo TAVI with a 26-mm Myval™ transcatheter heart valve (Meril Life Sciences, Vapi, Gujarat, India). Follow-up imaging confirmed the absence of significant PVL or TVL, with complete resolution of symptoms. This case underscores the importance of multimodal imaging and individualized management strategies, including redo TAVI, in the treatment of complex post-TAVI complications.

Keywords: Hypoattenuated leaflet thickening, hypoattenuation affecting motion, multimodal imaging, paravalvular leak, transcatheter aortic valve implantation, valve-in-valve procedure