Transcatheter aortic valve replacement for pure native aortic regurgitation

We report the case of a female patient in her 60s with advanced ovarian cancer and Trousseau's syndrome, who presented with a stroke. An unusual biphasic femoral flow led to transthoracic echocardiography that revealed a severe aortic regurgitation (AR) secondary to a prolapsed right coronary aortic valve leaflet. An initial echocardiography missed the diagnosis due to tachycardia. Transcatheter aortic valve replacement (TAVR) resulted in symptom improvement. She was readmitted 2 years later with prosthetic valve thrombosis, ultimately succumbing to oncological complications. This case highlights challenges in diagnosing AR and the potential role of TAVR in patients with native pure AR (NPAR). While TAVR for NPAR poses technical challenges, newer generation transcatheter heart valves (THVs) offer promising outcomes. The Acurate NEO 2 valve was successfully used in this case. TAVR with off-label THVs can be considered for selected NPAR patients, and we can expect increased utilisation of on-label devices when availability issues are solved.