Percutaneous closure of acute aorto-right ventricular fistula following transcatheter bicuspid aortic valve replacement

Kenta Nakamura; Jonathan J Passeri; Ignacio Inglessis-Azuaje

doi:10.1002/ccd.26705

Percutaneous closure of acute aorto-right ventricular fistula following transcatheter bicuspid aortic valve replacement

Catheter Cardiovasc Interv. 2017 Jul;90(1):164-168. doi: 10.1002/ccd.26705. Epub 2016 Aug 22.

Authors

Kenta Nakamura¹, Jonathan J Passeri², Ignacio Inglessis-Azuaje³

Affiliations

¹ Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
² Interventional Echocardiography, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
³ Adult Congenital Heart Disease Interventions, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

PMID: 27545308
DOI: 10.1002/ccd.26705

Abstract

We report a case of acute aorto-right ventricular fistula following transcatheter bicuspid aortic valve replacement and subsequent percutaneous closure. The diagnosis and treatment of this rare complication is illustrated through multi-modality imaging. We hypothesize that the patient's heavily calcified bicuspid aortic valve anatomy led to asymmetric deployment of the transcatheter aortic valve replacement (TAVR) prosthesis, traumatizing the right sinus of Valsalva at the distal edge of the TAVR stent and ultimately fistulized to the right ventricle. The patient acutely decompensated with heart failure five days after TAVR and underwent emergent intervention. The aorto-right ventricular fistula was closed using an 18-mm septal occluder device with marked clinical recovery. Transcatheter closure is a viable treatment option for acute aorto-right ventricular fistula. © 2016 Wiley Periodicals, Inc.

Keywords: aortic valve disease; fistula; percutaneous intervention; shunts; transcatheter valve implantation.

Publication types

Case Reports
Video-Audio Media

MeSH terms

Aortic Diseases / diagnostic imaging
Aortic Diseases / etiology
Aortic Diseases / therapy*
Aortic Valve / abnormalities*
Aortic Valve / diagnostic imaging
Aortic Valve / physiopathology
Aortic Valve / surgery
Aortography / methods
Bicuspid Aortic Valve Disease
Cardiac Catheterization* / instrumentation
Computed Tomography Angiography
Echocardiography, Doppler, Color
Echocardiography, Three-Dimensional
Echocardiography, Transesophageal
Heart Diseases / diagnostic imaging
Heart Diseases / etiology
Heart Diseases / therapy*
Heart Failure / etiology
Heart Valve Diseases / diagnostic imaging
Heart Valve Diseases / physiopathology
Heart Valve Diseases / surgery*
Hemodynamics
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Multimodal Imaging
Septal Occluder Device
Transcatheter Aortic Valve Replacement / adverse effects*
Transcatheter Aortic Valve Replacement / instrumentation
Treatment Outcome
Vascular Fistula / diagnostic imaging
Vascular Fistula / etiology
Vascular Fistula / therapy*