Late Bioprosthetic Valve Migration- A Rare Entity After Tavi

We present a case of hemolytic anemia due to a rare complication of late bioprosthetic valve migration, who underwent successful treatment with valve in valve transcatheter aortic valve implantation. Our patient with symptomatic moderate aortic stenosis underwent the index procedure a year ago and treated for bacteremia 3 months ago, presented with hemolytic anemia and echocardiography revealing aortic paravalvular leak. The hemolysis was attributed to Bioprosthetic valve dysfunction after a negative hematological workup. The patient's aortography revealed ventricular migration of the valve, not seen on a cardiac CT scan performed before. This was followed by a successful valve in valve transcatheter aortic valve implantation with improvements in all parameters.The improvement in reticulocyte count after successful intervention reinforces bioprosthetic valve dysfunction from late valve migration, a rare phenomenon, as the cause of hemolytic anemia. Our case shows a rare complication of the transcatheter aortic valve implantation procedure and its management with a valve in valve procedure, an indication not in guidelines yet.