Restoration of a Stuck Leaflet

Severe aortic regurgitation (AR) for a leaflet malfunction after transcatheter aortic valve implantation (TAVI) is a dreadful complication that can lead even to cardiogenic shock. New valve's design has reduced the rate of paravalvular regurgitation, however central regurgitation is still a challenging complication. An 88-year-old woman with severe aortic stenosis underwent TAVI with an Edwards Sapien III valve. After the procedure, angiography revealed third-degree angiographic central AR, causing hemodynamic instability. The team suspected a stuck leaflet and corrected it with catheter manipulation. The patient's condition stabilized, and follow-up echocardiography showed proper valve position and function. Severe AR following TAVI, while rare, can result in critical clinical deterioration. Recent evidence suggest that even mild grade of AR post-TAVI can affect long-term outcomes. This case has the aim to promote a prompt diagnosis and intervention on a stuck leaflet to reduce patient morbidity, hospitalization time, and resource utilization. This case illustrates the warning scenario of a severe central AR for a stuck leaflet after TAVI. Prompt recognition and management of this complication are crucial to improving clinical outcomes.