Early pannus after transcatheter heart valve implantation leading to delayed coronary obstruction: a case report

Abstract Background Coronary obstruction after transcatheter aortic valve implantation (TAVI) is a rare complication typically occurring acutely. Delayed coronary obstruction (DCO) due to early pannus formation is exceptionally uncommon. Case summary A 74-year-old woman with no coronary artery disease underwent TAVI with a self-expandable 26-mm Evolut Pro + (Medtronic) transcatheter heart valve (THV) six months prior. She presented with recurrent non-ST-segment elevation myocardial infarctions (NSTEMI), despite no angiographic evidence of acute coronary lesions. Multimodality imaging revealed early pannus overgrowth around the THV, causing mechanical obstruction of the left main ostium. Following Heart Team discussion, she underwent successful coronary artery bypass grafting without the need for surgical THV intervention. Discussion This case highlights a rare cause of DCO post-TAVI. Both orthotopic chimney stenting and THV explant with surgical valve replacement were deemed unsuitable in this context.