Aortico-Right Ventricular Shunt Following Aortic Valve Replacement

Lorenz, Javier; Reddy, C.V.R.; Khan, Rahman; Hoover, Eddie L.; Hsu, Hwei-Kang; El‐Sherif, Nabil

doi:10.1378/chest.83.6.922

Cited by 20 publications

(21 citation statements)

References 13 publications

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“…In general, ARV fistulas have been described to occur because of rupture of congenital and acquired sinus of Valsalva aneurysms. Although rare, blunt trauma to the chest, penetrating chest trauma, aortic dissection, high ventricular septal defect repair and aortic valve surgery have been reported to result in ARV fistula [5,6] . Because ARV fistulas are uncommon, the true incidence is unknown.…”

Section: Discussionmentioning

confidence: 99%

“…Several mechanisms may lead to cardiac shunts during aortic valve surgery including unintentional injury to the membranous septum sustained during dissection below the noncoronary cusps, perivalvular damage attributable to improper retraction and excessive and aggressive debridement of bulky areas of calcification from the aortic annulus [5][6][7][8][9][10][11][12][13][14][15][16][17] and/or pseudo-aneurysm formation secondary to degenerative changes at the aortotomy line and the pseudo-aneurysm's eventual rupture into the RV [1] . Lorenz et al proposed ischemic necrosis because of inappropriate suturing of the mechanical valve if the membranous portion of the ventricular septum is included in the prosthetic valve suture line [5] . In our case, ARV fistula occurred early after aortic valve replacement and intraoperative examination of the native aortic valve demonstrated heavily calcified areas.…”

Section: Discussionmentioning

confidence: 99%

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Aorto-right ventricular fistula: An early complication of aortic valve replacement

Triki

Kahla

Hammami

et al. 2015

CRIM

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The implantation of prosthetic heart valves has been associated with several kinds of complications, but the description of aorto-right ventricle (ARV) fistula as a complication of aortic valve replacement is a very rare finding. We report herein the case of a 56-year-old woman sought care for palpitations two months after prosthetic aortic and mitral valve replacement. Cardiac examination revealed normally audible mechanical sounds with a new loud to-and-fro murmur with continuous precordial thrill. Thyroid function tests were poorly balanced (raised FT4 and lowered TSH). Electrocardiography at admission displayed rapid heart rhythm with atrial fibrillation. Trans-thoracic echocardiography (TTE) revealed left-to-right shunt due to aorto-RV fistula. We discuss then the aetiology, diagnosis and management of this rare para-valvular leakage.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Aorto-right ventricular fistula: An early complication of aortic valve replacement

Triki

Kahla

Hammami

et al. 2015

CRIM

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“…Although rare, blunt trauma to the chest, penetrating chest trauma, aortic dissection, high ventricular septal defect repair, 2) and aortic valve surgery [2][3][4][5] have been reported to result in aorto-RV fistula. The true incidence of aorto-RV fistula after aortic valve surgery is unknown.…”

Section: Discussionmentioning

confidence: 99%

“…Several mechanisms of injury causing cardiac shunts during aortic valve surgery have been proposed, including inadvertent injury to the membranous septum during dissection below the noncoronary cusps, perivalvular damage attributable to improper retraction and excessive debridement of calcium from the annulus, 2,4) and pseudoaneurysm formation secondary to degenerative changes at the aortotomy line and the pseudoaneurysm's eventual rupture into the RV. 1) Lorenz et al 2) proposed that another cause may be inclusion of the membranous portion of the ventricular septum in the prosthetic valve suture line, causing ischemic necrosis and eventual development of aorto-RV fistula.…”

Section: Discussionmentioning

confidence: 99%

“…1) Lorenz et al 2) proposed that another cause may be inclusion of the membranous portion of the ventricular septum in the prosthetic valve suture line, causing ischemic necrosis and eventual development of aorto-RV fistula. Aorto-RV fistula after prosthetic aortic valve replacement secondary to the trauma sustained during surgery has also been reported.…”

Section: Discussionmentioning

confidence: 99%

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Aorto–right Ventricular Fistula: A Complication of Aortic Valve Replacement

Najib¹,

Ng²,

Vinales³

et al. 2012

ATCS

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The occurrence of aorto-right ventricular (aorto-RV) fistula after prosthetic aortic valve replacement is rare. Transthoracic echocardiography (TTE) with color-flow Doppler, transesophageal echocardiography (TEE), or both may be required for diagnosis. A 42-yearold woman sought care for palpitations and dyspnea due to atrial flutter 2 weeks after prosthetic aortic valve replacement and graft replacement of the ascending aorta. TTE and TEE revealed left-to-right shunt due to aorto-RV fistula.

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Transcatheter closure of an iatrogenic aorto‐right ventricular fistula

Lebreiro

Silva

2011

Cathet Cardio Intervent

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Aortocardiac fistulas are rare, especially if they develop after an aortic valve replacement surgery. We report the case of a 54-year-old male submitted to aortic valve replacement and implantation of an ascending aortic prosthetic graft, complaining of exertional dyspnea, who was found to have significant shunt between the aortic root and right ventricle (RV), and de novo moderate pulmonary hypertension. At the catheterization laboratory, the left-to-right shunt was confirmed (Qp:Qs = 1.9:1). Contrast angiography of the ascending aorta showed a significant flow into the right ventricular cavity, and the fistulous tract was then measured, inflating a Tyshak II balloon of 10 × 20 mm (NuMED, Hopkinton, New York), until achieving a complete interruption of flow. Minimal diameter of the defect was 4.9 mm. Percutaneous closure of the aorto-RV shunt was performed under general anesthesia and transesophageal echocardiogram and fluoroscopic guidance. Using a venous and an arterial femoral access, a 0.035″ hydrophilic guide-wire crossed the defect between the aorta and RV, creating an arteriovenous loop. Then, using a 7F Delivery System 45° (AGA medical corporation, Golden Valley, MN) an Amplatzer Duct Occluder(®) (AGA Medical Corporation) 8/6 mm was advanced and released within the defect, achieving an almost complete closure of the fistulous tract.

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Aortico-Right Ventricular Shunt Following Aortic Valve Replacement

Cited by 20 publications

References 13 publications

Aorto-right ventricular fistula: An early complication of aortic valve replacement

Aorto-right ventricular fistula: An early complication of aortic valve replacement

Aorto–right Ventricular Fistula: A Complication of Aortic Valve Replacement

Transcatheter closure of an iatrogenic aorto‐right ventricular fistula

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