Transcatheter Closure of Aorta to Left Atrium Fistula during Active Prosthetic Valve Endocarditis as a Bridge for Surgery: A Case Report

Naeim, Hesham Abdo; Abuelatta, Reda; Alamodi, Osama; Saeed, Waleed; El-Mohamady, Hala S.; Mahmood, Abeer; Alharbi, Ibraheem

doi:10.1016/j.case.2019.08.004

Cited by 1 publication

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References 11 publications

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“… 10 , 12 Several cases reported successful transcatheter closure of AAF using Amplatz plugs with promising short-term outcomes. 13–15 Naeim et al reported transcatheter closure of AAF using two AVP II devices in a patient with active IE as a bridge to surgery; 14 For post-operative AAF after surgical aortic valve replacement, Alkhouli et al reported an immediate complete seal of AAF with an ADO-II device 15 and Estévez-Loureiro et al with two AVP III occluders. 13 Potential complications associated with this approach include impingement of the valve, device embolization, stroke, and coronary artery obstruction.…”

Section: Discussionmentioning

confidence: 99%

Case report: Concomitant MitraClip implantation for severe mitral regurgitation and plug closure of endocarditis induced fistula between aortic root and left atrium after transcatheter aortic valve implantation

Ren

Jaegere

Mieghem

2021

European Heart Journal - Case Reports

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Background Infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) occurs in up to 1.5% of patients within the first year. The development of an aorto-atrial fistula (AAF) is a rare but problematic complication of IE, which can be confirmed with transoesophageal echocardiography (TOE). We present an exceptional case of occluding an aorto-left atrial fistula only diagnosed with intraprocedural TOE during a subsequent procedure of MitraClip implantation. Case summary A 79-year-old symptomatic male patient with multiple comorbidities was referred due to severe mitral regurgitation (MR). He has had prior TAVI which was complicated with streptococcal IE for which he had received prolonged antibacterial therapy. Transthoracic echocardiography (TTE) revealed severe MR. The patient was accepted for a MitraClip procedure by the heart team. Intra-procedural TOE revealed also a significant continuous shunt through an AAF which was likely caused by the endocarditis. The strategy was therefore defined as to occlude the fistula with an Amplatzer Vascular Plug II 12 mm. The plug was released in the fistula leaving an insignificant residual shunt. After the transseptal puncture one MitraClip XTR was implanted, reducing the MR to mild. After the procedure, the patient’s general clinical condition improved without signs of haemolysis. The pre-discharge TTE confirmed trace residual shunt, mild residual MR and mild paravalvular leakage. Discussion Our case illustrates a complex transcatheter structural heart intervention with improvised procedural strategies based on the intra-procedural TOE findings. We conclude that the pre-procedural TOE needs to be comprehensive rather than exclusive, particularly in the context of bioprosthesis-related endocarditis.

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