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

Najib, Mohammad Q.; Ng, Daniel W.C.; Vinales, Karyne L.; Chaliki, Hari P.

doi:10.5761/atcs.cr.11.01671

Cited by 8 publications

(4 citation statements)

References 7 publications

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“…Annual follow-up of iatrogenic ARV fistulas in asymptomatic patients with small shunts has been proposed. 9 We feel that due to the rarity of this complication and complexity in planning definitive treatment, these cases should initially be followed at the 1st, 3rd, and 6th months post-procedure to ensure no clinical or echocardiographic deterioration occurs. If the patients are clinically stable with no signs of right ventricular loading they could then be followed up annually.…”

Section: Discussionmentioning

confidence: 99%

Successful percutaneous closure of aortic root-to-right ventricle fistula after transcatheter aortic valve implantation: a valuable option in high-risk surgical patients

Vrettos

Duncan

Ahmed

et al. 2022

European Heart Journal - Case Reports

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Background Aortic-to-right ventricle (ARV) fistula is an uncommon complication of transcatheter aortic valve implantation (TAVI). Even though surgical closure is usually the treatment of choice in such communications, percutaneous treatment options are valuable alternatives for these high-risk surgical patients. Case Summary In this paper, we present the percutaneous closure of an ARV fistula after TAVI, in a highly symptomatic patient with recurrent episodes of heart failure decompensation with worsening right ventricular function, who failed conservative medical treatment and was deemed inoperable. Successful closure of the fistula with the use of the Amplatzer atrial septal occluder was performed 6 months post TAVI, under general anaesthesia and transoesophageal echocardiography (TOE). A detailed multi-modality imaging pre-procedural planning was performed utilizing 4D cardiac computed tomography (CT) and echocardiography. The patient has remained asymptomatic and in good health 5 months after the ARV fistula closure, with marked improvement in his clinical picture and echocardiographic parameters. Discussion ARV fistulas with significant shunt post TAVI could lead to biventricular failure and are associated with increased mortality if left untreated. This case demonstrates that TOE guided percutaneous closure of a TAVI related ARV fistula, although technically challenging, is feasible, and can be a valuable option for the treatment of symptomatic highrisk surgical patients.

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Section: Discussionmentioning

confidence: 99%

Successful percutaneous closure of aortic root-to-right ventricle fistula after transcatheter aortic valve implantation: a valuable option in high-risk surgical patients

Vrettos

Duncan

Ahmed

et al. 2022

European Heart Journal - Case Reports

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“…Most of the AAFs develop secondary to bacterial endocarditis, paravalvular abscess, ruptured sinus of valsalva, aortic dissection and a possible congenital etiology . TTE and TEE may be helpful for the diagnosis .…”

Section: Case Presentationmentioning

confidence: 99%

Aorto–Left Atrial Fistula after Mitral Valve Surgery

et al. 2015

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Case Presentation:A 41-year-old woman was admitted to our outpatient clinic with ongoing dyspnea. She had undergone mitral valve surgery with a 29-mm Carbomedics mechanical prosthetic valve 4 months ago following failed mitral valve repair with ring annuloplasty for rheumatic mitral valve disease. A continuous murmur was heard all over the precordium during physical examination. Laboratory findings were unremarkable, and international normalized ratio (INR) was therapeutic (2.3). Electrocardiography showed sinus rhythm. Transthoracic echocardiography (TTE) showed increased mitral transvalvular gradients (23/ 9 mmHg) (Fig. 1A), and two jets that originated from the aorta (one was aortic regurgitation and the other was fistula to the left atrium) were assessed by color Doppler imaging in the apical five-chamber view (Fig. 1B). Subsequently twodimensional (2D) transesophageal echocardiography (TEE) was performed which showed a continuous regurgitant jet extending from the aorta to Figure 1. Transthoracic echocardiography showed increased transvalvular gradients by continuous-wave Doppler imaging A. and two regurgitant jets that originated from the aorta (one was severe aortic regurgitation, and the other was fistula to the left atrium) were assessed by color Doppler imaging in the apical five-chamber view (arrows) B. LA = left atrium; LV = left ventricle; PMV = prosthetic mitral valve.

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“…Iatrogenic aorto-right ventricular fistula is a rare complication of surgical and transcatheter aortic valve replacement (TAVR) that typically requires prompt recognition and treatment to avoid high mortality when associated with significant left-to-right shunt [1][2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

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

Nakamura

Passeri

Inglessis‐Azuaje

2016

Cathet Cardio Intervent

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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.

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

Cited by 8 publications

References 7 publications

Successful percutaneous closure of aortic root-to-right ventricle fistula after transcatheter aortic valve implantation: a valuable option in high-risk surgical patients

Successful percutaneous closure of aortic root-to-right ventricle fistula after transcatheter aortic valve implantation: a valuable option in high-risk surgical patients

Aorto–Left Atrial Fistula after Mitral Valve Surgery

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

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