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A 67-year-old woman with severe aortic stenosis underwent TAVI, during which subvalvular stent compression resulted in an “olive sign” deformation on TEE. This sign indicated valve instability, leading to migration into the ascending aorta. A valve-in-valve strategy was successfully used to achieve a tandem configuration.
⚕️ Key Clinical Considerations ⚕️
- The “olive sign” on TEE represents subvalvular stent compression and valve instability
- Valve migration into the ascending aorta occurred immediately after initial deployment
- Unevenly distributed calcification may prevent circumferential contact between the valve stent and annulus
- A valve-in-valve approach in tandem configuration corrected the complication
- Only mild aortic regurgitation was noted post-procedure
🎯 Clinical Practice Impact 🎯
- Recognize the “olive sign” on TEE as an indicator of TAVI valve instability
- Anticipate potential valve migration when the “olive sign” is observed
- Consider a valve-in-valve bailout strategy for cases of valve migration
- Assess valve calcification pattern pre-TAVI to predict subvalvular compression risk
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