Cryoextraction for Airway Bleeding After Valve-in-Valve Procedure.
This is a single case report describing successful bronchoscopic cryoextraction of obstructive airway clots in an 84-year-old woman with severe hemoptysis and hypoxia following transcatheter tricuspid valve-in-valve implantation with a 24.5-mm Myval.
Two cryoextraction sessions 72 hours apart cleared the airway, and the patient was extubated and discharged after 7 days.
Hemoptysis after transcatheter valve implantation is rare and its mechanism here is not established — the report does not resolve whether bleeding reflected pulmonary venous congestion, mechanical injury, anticoagulation effect, or another cause.
A single case cannot support a management pathway, and cryoextraction is a technique available only where interventional pulmonology is on call.
BACKGROUND: Hemoptysis after percutaneous valve implantation is a rare but life-threatening complication. CASE SUMMARY: An 84-year-old woman with prior mechanical aortic and biological tricuspid valve replacements presented with tricuspid stenosis and regurgitation. A transcatheter valve-in-valve procedure using a 24.5-mm Myval was performed successfully. However, she developed severe hemoptysis, hypoxia, and ventilation difficulties shortly after the procedure. Flexible bronchoscopy with cryoprobe-assisted clot extraction was performed, removing large obstructive clots from the bronchi. A second cryoextraction was necessary 72 hours later. The patient improved rapidly, was extubated, and was discharged in stable condition after 7 days. DISCUSSION: Cryoextraction is commonly used for tumor-related airway bleeding and foreign body removal, but its application in postvalve implantation hemoptysis is novel. This case highlights its lifesaving role. TAKE-HOME MESSAGE: Cryoextraction can be a safe and effective alternative when conventional bleeding control methods fail after valve implantation.
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