Acquired Aseptic Intracardiac Shunts Following Transcatheter Aortic Valve Replacement

Abstract

Post-TAVR AICS are uncommon but have high 30-day mortality if left untreated, especially in symptomatic patients. Percutaneous closure was feasible and safe in symptomatic patients but remains controversial in asymptomatic subjects.

Three-dimensional echocardiographic imaging of a Gerbode defect complicating transcatheter aortic valve replacement

“…Possible mechanisms involved could be a direct compression of calcification into the membranous septum, oversizing of the prosthesis, heavily calcified aortic valve leaflets, and a narrowed, calcified, or oval-shaped aortic annulus. [5] In our case, there was an asymmetrical and delayed expansion of the valve due to a likelihood different degree of calcific degeneration of the two emi-annulus with the side of the right perimembranous septum less expandable; as a result, it might have favored the formation of the Gerbode defect as reported in literature. The defect of membranous septum can be divided into two types as follows: ventricular and atrioventricular.…”

“…Reported treatments have included percutaneous closure, surgical repair, and conservative strategies, keeping in mind that smaller shunts even though may be tolerated for a time, in a longer term, follow-up might reveal progressive clinical deterioration. [12345] With the growing number of TAVR, it is important to recognize this complication procedure related. The location of VSD is adjacent to the valve landing zone, in the membranous or perimembranous part of the septum.…”

Transcatheter Closure of Left Ventricular Outflow Tract–to–Left Atrium Fistula

“…Iatrogenic intracardiac shunts can occur after SAVR as a result of direct mechanical injury ( 1 ) or, less commonly, after transcatheter aortic valve replacement (TAVR) with compression of annular calcium during valve expansion or direct mechanical trauma by the delivery system, including the introducer ( 2 ). Severely calcified annulus, prosthesis oversizing, aortic root enlargement, and deeper valve implantation can potentially increase the risk for this complication ( 1 ).…”

Transcatheter aortic valve replacement in membranous interventricular septum aneurysm with left ventricular outflow tract extension

“…Malposition of valve can result in valve migration and resulting more severe para-valvular leak or embolization in high supra-annular placement vs more chances of AV conduction blocks in sub-annular placement[ 10 ]. Other complications including post TAVR shunts have also been reported[ 11 ]. Careful placement of the prosthetic valve in a more aortic position like in our case can be the solution despite the presence of aneurysm at the sub-aortic level.…”