{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T13:10:49Z","timestamp":1760447449641,"version":"build-2065373602"},"reference-count":11,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T00:00:00Z","timestamp":1760400000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T00:00:00Z","timestamp":1760400000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Gen Thorac Cardiovasc Surg Cases"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Infolding is a rare but potentially life-threatening complication of self-expanding transcatheter aortic valve replacement (TAVR).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Case presentation<\/jats:title>\n            <jats:p>We describe the case of an 80-year-old man who was referred for the treatment of severe aortic stenosis complicated by heart failure. Transthoracic echocardiography revealed the following: peak velocity, 6.1\u00a0m\/s; mean pressure gradient, 102\u00a0mmHg; and aortic valve area, 0.26\u00a0cm<jats:sup>2<\/jats:sup>. Computed tomography (CT) showed a bicuspid aortic valve with a R-L raphe, an annular area of 529\u00a0mm<jats:sup>2<\/jats:sup>, and a perimeter of 83.4\u00a0mm. Considering the patient\u2019s severe emphysema, transfemoral TAVR was performed with the patient under deep sedation. A 34-mm Evolut FX valve was implanted after predilation with a 20-mm Inoue balloon. During deployment up to the point of no recapture, hypotension occurred without improvement, and mild infolding was suspected. However, full deployment was performed, as valve optimization was considered likely to stabilize hemodynamics. Post-deployment balloon dilation was performed; however, valve under-expansion and moderate aortic regurgitation persisted. Initial hemodynamics were stabilized; however, the patient gradually developed respiratory distress. Follow-up CT confirmed substantial valve infolding. Pulmonary hypertension, alveolar hemorrhage, and disseminated intravascular coagulation developed. Surgical aortic valve replacement with a 21-mm valve was performed 15\u00a0days post-TAVR. The explanted TAVR valve exhibited marked structural deformation. Although the patient\u2019s circulatory status improved postoperatively, he died of respiratory failure due to pneumonia.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>This case highlights the importance of comprehensive preoperative anatomical assessment and intraoperative decision making in high-risk patients, particularly those with bicuspid valves. Valve selection (considering the valve type and size) must be meticulously tailored to the anatomical features surrounding the annulus. In addition, upon its recognition, substantial infolding should be promptly addressed by recapturing the valve, adjusting the valve size, or redeploying the valve with additional balloon aortic valvuloplasty.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s44215-025-00224-3","type":"journal-article","created":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T12:37:02Z","timestamp":1760445422000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Fatal outcome after self-expanding transcatheter aortic valve replacement of the bicuspid valve due to infolding: a case report"],"prefix":"10.1186","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-2382-5640","authenticated-orcid":false,"given":"Nagi","family":"Hayashi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junji","family":"Yunoki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keijiro","family":"Shigetomi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kouhei","family":"Baba","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masahide","family":"Shichijo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Koki","family":"Jinnouchi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroyuki","family":"Morokuma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manabu","family":"Itoh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keiji","family":"Kamohara","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,10,14]]},"reference":[{"key":"224_CR1","first-page":"1226","volume":"133","author":"S Hans-H.","year":"2007","unstructured":"Hans-H. S, Claudia S. A classification system for the bicuspid aortic valve from 304 surgical specimens. JTCVS. 2007;133:1226\u201333.","journal-title":"JTCVS"},{"key":"224_CR2","doi-asserted-by":"publisher","first-page":"789","DOI":"10.1016\/j.jcin.2019.11.035","volume":"13","author":"A Musallam","year":"2020","unstructured":"Musallam A, Rogers T, Ben-Dor I, Torguson R, Khan JM, Satler LF, et al. Self-expanding transcatheter aortic valve-frame infolding: a case series with a warning message. JACC Cardiovasc Interv. 2020;13:789\u201390.","journal-title":"JACC Cardiovasc Interv"},{"key":"224_CR3","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1016\/j.amjcard.2024.04.010","volume":"221","author":"A Bezzeccheri","year":"2024","unstructured":"Bezzeccheri A, Poletti E, Vermeersch P, Veulemans V, Piuhola J, Kerkel\u00e4 S, et al. Prosthesis infolding incidence and short-term outcomes in transcatheter aortic valve implantation using Evolut self-expandable device: a multicenter study. Am J Cardiol. 2024;221:102\u20139.","journal-title":"Am J Cardiol"},{"key":"224_CR4","doi-asserted-by":"publisher","first-page":"100008","DOI":"10.1016\/j.shj.2022.100008","volume":"6","author":"V Veulemans","year":"2022","unstructured":"Veulemans V, Piuhola J, Niemel\u00e4 M, Maier O, Piayda K, Polzin A, et al. Incidence and risk assessment of infolding using self-expandable devices in TAVR. Struct Heart. 2022;6:100008.","journal-title":"Struct Heart"},{"key":"224_CR5","first-page":"e43847","volume":"15","author":"F Mohammed","year":"2023","unstructured":"Mohammed F, Gubitosa JC, Huffman TR, Abdul-Waheed M, Rafeedheen R. A case of cardiac arrest due to transcatheter aortic valve infolding. Cureus. 2023;15:e43847.","journal-title":"Cureus"},{"key":"224_CR6","first-page":"e10093","volume":"12","author":"W Karrowni","year":"2020","unstructured":"Karrowni W, Fakih S, Nassar P. Infolding of self-expandable transcatheter heart valve: case report and review of literature. Cureus. 2020;12:e10093.","journal-title":"Cureus"},{"key":"224_CR7","doi-asserted-by":"publisher","first-page":"e007107","DOI":"10.1161\/CIRCINTERVENTIONS.118.007107","volume":"12","author":"D Tchetche","year":"2019","unstructured":"Tchetche D, de Biase C, van Gils L, Parma R, Ochala A, Lefevre T, et al. Bicuspid aortic valve anatomy and relationship with devices: the BAVARD multicenter registry. Circ Cardiovasc Interv. 2019;12:e007107.","journal-title":"Circ Cardiovasc Interv"},{"key":"224_CR8","doi-asserted-by":"publisher","first-page":"e231","DOI":"10.4244\/EIJ-D-19-00236","volume":"15","author":"WK Kim","year":"2019","unstructured":"Kim WK, Renker M, Rolf A, Fischer-Rasokat U, Wiedemeyer J, Doss M, et al. Annular versus supra-annular sizing for TAVI in bicuspid aortic valve stenosis. EuroIntervention. 2019;15:e231\u20138.","journal-title":"EuroIntervention"},{"key":"224_CR9","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1111\/joic.12267","volume":"29","author":"P Fonseca","year":"2016","unstructured":"Fonseca P, Figueiredo B, Almeida C, Almeida J, Bettencourt N, Sampaio F, et al. Aortic valve calcium volume predicts paravalvular regurgitation and the need for balloon post-dilatation after transcatheter aortic valve implantation. J Interv Cardiol. 2016;29:117\u201323.","journal-title":"J Interv Cardiol"},{"key":"224_CR10","first-page":"E299","volume":"98","author":"MB Ancona","year":"2021","unstructured":"Ancona MB, Beneduce A, Romano V, Buzzatti N, Russo F, Bellini B, et al. Self-expanding transcatheter aortic valve infolding: current evidence, diagnosis, and management. Catheter Cardiovasc Interv. 2021;98:E299-305.","journal-title":"Catheter Cardiovasc Interv"},{"key":"224_CR11","first-page":"102394","volume":"3","author":"R Shah","year":"2024","unstructured":"Shah R, Bolaji O, Bahar Y, Sah R, Ariaga AC, Paul TK, et al. Strategic management of valve infolding in Evolut TAVR procedures: enhancing outcomes and ensuring patient safety. J Soc Cardiovasc Angiogr Interv. 2024;3:102394.","journal-title":"J Soc Cardiovasc Angiogr Interv"}],"container-title":["General Thoracic and Cardiovascular Surgery Cases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s44215-025-00224-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s44215-025-00224-3\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s44215-025-00224-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T12:37:16Z","timestamp":1760445436000},"score":1,"resource":{"primary":{"URL":"https:\/\/gtcscases.biomedcentral.com\/articles\/10.1186\/s44215-025-00224-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,14]]},"references-count":11,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["224"],"URL":"https:\/\/doi.org\/10.1186\/s44215-025-00224-3","relation":{},"ISSN":["2731-6203"],"issn-type":[{"value":"2731-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,14]]},"assertion":[{"value":"28 June 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 September 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 October 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The need for ethical review and approval were waived by the ethics committee of our hospital, as case reports are exempt from review in accordance with institutional policy.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtained from the patient for publication of this case report and accompanying images.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"39"}}