Unusual cause of myocardial infarction following transcatheter aortic valve replacement.

An 81-year-old female presented for elective transcatheter aortic valve replacement (TAVR) for severe low-flow low-gradient aortic stenosis. Immediately post-procedure, she developed unexplained, persistent hypotension. There was no bleeding. There was no aortic injury. Activated clotting time was in therapeutic range. Coronary angiography revealed hazy filling defects in left anterior descending and left circumflex. Intravascular ultrasound showed heterogeneous, hypoechoic mass with mild calcification consistent with embolized valve leaflet tissue. This was treated with emergent percutaneous coronary intervention with excellent results. Left coronary artery embolism from aortic valve leaflet tissue is a rare, but potentially life-threatening complication following TAVR. Prompt recognition is key to a successful outcome.