The “PAC-MAN” sign: an insidious complication after transcatheter aortic valve deployment

Transcatheter aortic valve implantation (TAVI) is now a viable and effective alternative to conventional surgical aortic valve replacement for high-risk patients with severe aortic stenosis. Despite its percutaneous and less invasive nature, TAVI is associated with the potential for several intraprocedural complications, which have been recently updated and standardized. Some of them, such as those relating to valve deployment and/or positioning, occur less frequently but they could however represent very serious and life-threatening complications. We report the case of an insidious TAVI complication that required a combined fluoroscopic/echocardiographic approach in order to allow a correct deployment of the transcatheter prosthesis. Our case report highlights this potentially specific under-deployment of large CoreValve prosthesis. Medico-surgical community involved in TAVI must be nowaware of this newtype of complication allowing its successful management.