Worsening Mitral Stenosis Due to Post-transcatheter Aortic Valve Replacement Improvement of Concomitant Aortic Insufficiency

Transcatheter aortic valve replacement (TAVR) has become an alternative to surgical treatment in severe aortic valve stenosis, with expanding indications and rapidly growing number of performed procedures. Poor opposition of TAVR prosthesis to the aortic root causes paravalvular leak, while mitral regurgitation and stenosis have been associated with valve implantation low in the left ventricular outflow tract (LVOT). We report an unusual case of a patient with combined severe aortic stenosis and moderate aortic insufficiency who underwent elective TAVR, which resulted in significant increase of a pre-existing mitral valve gradient. Rapid post-TAVR increase in mitral valve gradient was likely due to improvement in aortic regurgitation and decreased left ventricular end-diastolic pressure (LVEDP).