Transcatheter closure of an iatrogenic ventricular septal defect after SAPIEN valve implantation

Abstract

A 57-year-old woman developed progressive calcific mitral and aortic valve disease with a porcelain aorta secondary to a history of radiation therapy. She was considered a very poor operative candidate and referred for transcatheter aortic valve replacement (TAVR). Four weeks after extensive coronary artery stenting, a TAVR was performed with a 23 mm Edwards SAPIEN valve (Edwards Life Sciences, Irvine, CA) through a transapical approach. Post-operatively, her symptoms of dyspnea persisted and worsened. She was found to have an acquired ventricular septal defect (VSD) measuring 8 mm by 5 mm by transesophageal echocardiogram and by a CT angiogram. Percutaneous VSD closure was accomplished with an 8 mm Muscular VSD Occluder (St. Jude Medical, St. Paul, MN) with elimination of her shunt, improvement of her dyspnea, and marked improvement in exercise tolerance.

Successful Closure of a Ventricular Septal Defect Using a Novel Non-Prosthesis Touching Technique Following Mechanical Aortic Valve Replacement

“…A significant concern for the use of an arterio-venous loop in transcatheter closure of iatrogenic VSDs is the interference with valve function by placement of the device [1-5]. Drop of systemic blood pressure [1, 3-5], and transient significant aortic regurgitation were observed when the device was across the leaflet of the aortic valve [4].…”

“…Drop of systemic blood pressure [1, 3-5], and transient significant aortic regurgitation were observed when the device was across the leaflet of the aortic valve [4]. To maintain a stable blood pressure, vasopressors were used [4].…”

“…Percutaneous transcatheter closure of these iatrogenic VSDs has increasingly become the preferred choice of therapy [1]. Since Holzer and colleagues reported two cases of successful percutaneous retro-aortic closure of iatrogenic VSD in 2004 [2], a few more similar case reports have been published [1, 3-5].…”

“…Percutaneous transcatheter closure of these iatrogenic VSDs has increasingly become the preferred choice of therapy [1]. Since Holzer and colleagues reported two cases of successful percutaneous retro-aortic closure of iatrogenic VSD in 2004 [2], a few more similar case reports have been published [1, 3-5]. An arterio-venous loop has been used for occluder deployment during the standard percutaneous procedure, entailing the risk of device impingement on the prosthetic aortic valve, which may cause serious complications or even death [1-6].…”

“…Since Holzer and colleagues reported two cases of successful percutaneous retro-aortic closure of iatrogenic VSD in 2004 [2], a few more similar case reports have been published [1, 3-5]. An arterio-venous loop has been used for occluder deployment during the standard percutaneous procedure, entailing the risk of device impingement on the prosthetic aortic valve, which may cause serious complications or even death [1-6]. In this report, we described a novel no-prosthesis-touching technique using an apex-venous loop for successful closure of a VSD in a patient following aortic valve replacement.…”