A Case of Cardiac Arrest Due to Transcatheter Aortic Valve Infolding.

Prosthetic valvular infolding during transcatheter aortic valve implantation (TAVI) is an under-recognized yet significant complication that can occur. Here, we describe the case of a 61-year-old male with a history of heart failure with reduced ejection fraction (HFrEF) and low-flow, low-gradient severe aortic valve stenosis of a bicuspid aortic valve who presented to undergo TAVI. During the procedure, repositioning of the valve resulted in prosthetic valvular infolding and resultant severe aortic regurgitation (AR), culminating in cardiac arrest. Swift balloon valvuloplasty corrected the valve geometry and eliminated any AR, allowing hemodynamic recovery and completion of the procedure. Our case and review highlight methods, both angiographic and echocardiographic, to recognize prosthetic valvular infolding the moment it presents, as well as strategies to correct the infolding with minimal detriment to the patient.

High output heart failure as a result of an ilio-caval fistula with a negative shunt series.

Congestive heart failure (CHF) with high cardiac output is an uncommon, yet attributable result of non-hemodialysis arteriovenous malformations. While the prevalence of high output heart failure has yet to be determined, it is observably low - specifically when looking at cases of high output heart failure as a result of ruptured abdominal aortic aneurysms (AAA) with fistula formation, an entity that carries a reported incidence of <1% of all complications of AAA. In this report, we present a 64-year-old male with high output heart failure secondary to a ruptured right common iliac aneurysm causing right ilio-iliac and ilio-caval fistulas.