Delayed Migration of a Transcatheter Aortic Valve Into the Left Ventricular Outflow Tract

Background: Late device migration is a rare complication of the transcatheter aortic valve replacement procedure. Case Summary: This is a 60-year-old man with a medical history of surgical aortic valve replacement with subsequent transcatheter aortic valve replacement who presented to the emergency department for chest discomfort and dyspnea. The transthoracic echocardiogram showed moderate prosthetic aortic regurgitation and severe prosthetic aortic valve stenosis, with evidence of valve migration. The patient underwent a successful transcatheter aortic valve-in-valve replacement. Discussion: Transcatheter heart valve migration, typically occurring shortly after deployment, is uncommon in late presentations, with few cases reported. Migration occurs when retrograde forces overcome the strength of the valve's endothelial attachment. Previous surgical aortic valve replacement, worsening heart failure, and endothelial dysfunction may have played a role in migration. Take-Home Messages: Transcatheter heart valve migration is a potentially lethal complication. Patients presenting with acute heart failure and known bioprosthesis require prompt evaluation with echocardiography.