Late severe left ventricular dysfunction after successful transapical aortic valve implantation: a cause for concern.

An 88-year-old man with severe aortic stenosis and normal left ventricular ejection fraction underwent transcatheter aortic valve implantation via a transapical approach, without periprocedural complications. Some 16 months later the patient was readmitted because of worsening dyspnea, when left ventricular dysfunction due to apical akinesia was identified. A gated, rest-only myocardial single-photon emission computed tomography (G-SPECT) demonstrated apical hypoperfusion that persisted after attenuation correction. Necrosis involved the apical and mid-inferior wall, the apical lateral wall, and the apical segment.