Iatrogenic aortic valve injury following invasive cardiac procedures: a case series of six patients

Abstract Background Aortic valve injury during cardiac catheterisation is an under-recognised complication that may present with new-onset aortic regurgitation or valvular masses, and mimic infective endocarditis or primary valve tumours (1, 2). Early recognition is crucial to avoid delayed diagnosis and suboptimal outcomes. Purpose This study aims to highlight the clinical features, diagnostic challenges, and outcomes of patients with presumed iatrogenic aortic valve injury following cardiac catheterisation or ablation procedures. Methods We retrospectively reviewed six male patients (mean age 57 years; range 43–76) referred to our centre between 2021 and 2023 with new-onset aortic regurgitation and echocardiographic findings of mobile valvular masses after recent invasive cardiac procedures. All patients underwent transthoracic and transoesophageal echocardiography. Infective endocarditis was excluded by negative blood cultures, absence of systemic signs of infection, and surgical pathology in selected cases. Surgical management and outcomes were also recorded. Echocardiographic and intraoperative images from the six patients are shown in Figure-1. Results All patients presented within weeks of cardiac catheterisation or ablation procedures. All six patients were male, with a mean age of 57 years (range 43–76). Presenting symptoms included dyspnoea, chest pain, palpitations, or weight loss. The triggering procedures varied and included diagnostic coronary angiography, PCI, and VT ablation. The time interval between the procedure and clinical presentation ranged from 4 days to 7 months. Echocardiography revealed moderate to severe aortic regurgitation in all cases, with mobile valvular structures identified on the affected cusps (RCC, NCC, or LCC). Five patients underwent valve surgery (aortic valve replacement or Bentall procedure) with histopathological examination confirming valvular tissue with no signs of infection or tumour. One patient is currently awaiting surgery. All patients recovered well postoperatively with no recurrence at follow-up. Detailed clinical, procedural and imaging data for each patient are summarised in Figure-2. Conclusion Iatrogenic injury of the aortic valve is a rare but important complication of catheter-based cardiac procedures. Clinicians should maintain a high index of suspicion in patients with new valvular findings after invasive interventions. Transoesophageal echocardiography is essential for diagnosis, and early surgical referral may improve outcomes.