Severe valve deformation following cardiopulmonary resuscitation in a patient with a transcatheter aortic valve.

Computed tomography angiogram showing severe calcification of the left ventricular outflow tract (LVOT) along the intravalvular fibrous curtain. A n 87-year-old patient with severe aortic stenosis underwent transapical transcatheter aortic valve replacement with a 26-mm Edwards Sapien valve (Edwards Lifesciences, Irvine, California). Pre-operative imaging was notable for severe asymmetric calcification along the posterolateral aspect of the left ventricular outflow tract (LVOT) involving the intravalvular fibrous curtain (Figure 1). The aortic annulus area measured 430 mm by computed tomographic imaging, allowing for 23% oversizing. Valve deployment was appropriate but was remarkable for moderate paravalvular regurgitation at the site of the LVOT calcification. The valve was redilated with an additional 1 ml of fluid added to the delivery balloon, modestly reducing the regurgitation. The patient recovered well and experienced mild heart failure symptoms. On hospital day 4, the patient experienced a cardiac arrest and underwent 48 min of cardiopulmonary resuscitation without return of spontaneous circulation. Autopsy demonstrated that the Sapien valve was crushed, with deformation of the valve at the site of the LVOT calcium (Figure 2, Online Video 1). Such severe valve distortion would have significantly impaired leaflet coaptation and function, and it is likely that