Delayed Stanford Type A Aortic Dissection Following Transcatheter Aortic Valve Implantation in a Patient With Pre-existing Ascending Aortic Dilatation

Acute aortic dissection is an exceptionally rare but potentially fatal complication of transcatheter aortic valve implantation (TAVI).Although most cases are recognized during or shortly after the procedure, delayed presentations following apparently uncomplicated TAVI have also been reported.An 81-year-old woman with severe symptomatic aortic stenosis and pre-existing ascending aortic dilatation of 45 mm underwent successful transfemoral TAVI with a 26-mm Hydra self-expanding transcatheter heart valve.Seven days later, she presented with sudden severe retrosternal chest pain radiating to the back and neck.Despite hemodynamic stability, a non-ischemic electrocardiogram, and normal serial high-sensitivity cardiac troponin I levels, the clinical presentation raised suspicion of acute aortic syndrome.Transthoracic echocardiography revealed an intimal flap in the ascending aorta.Emergency computed tomography angiography confirmed Stanford type A aortic dissection with associated intramural hematoma.The patient was immediately referred for emergency cardiothoracic surgery but deteriorated and died before definitive repair could be performed.Delayed aortic dissection should be considered in patients presenting with new severe chest pain after TAVI, even following an apparently uncomplicated procedure and in the presence of initially reassuring hemodynamic, electrocardiographic, and biomarker findings.Pre-existing ascending aortic dilatation may represent a vulnerable anatomical substrate and warrants careful consideration during pre-procedural assessment.A low threshold for urgent multimodality imaging is essential to facilitate early diagnosis and management of this rare but life-threatening complication.