Aorto-right ventricular fistula following percutaneous transcatheter aortic valve replacement: Case report and literature review

Abstract

An 88-year-old woman with a prior history of aortic stenosis and history of valvuloplasty presented with worsening symptoms of heart failure and dizziness. She underwent successful transcatheter aortic valve replacement (TAVR) without complications. Follow-up echocardiograms revealed a small fistula connecting aorta to the right ventricle. The patient was initially asymptomatic but 3 months later developed overload of the right ventricle and heart failure and chose to continue medical therapy. She died of progressive heart failure at 9 months from onset of fistula. Aorto-right ventricular fistula is a rare complication of TAVR with only four cases reported in literature thus far.

Supracristal Ventricular Septal Defect Complicated by Formation of an Aorto-Right Ventricular Outflow Tract Fistula: A Rare Cause of Biventricular Enlargement

“… 8 With the advent and increased use of transcatheter aortic valve replacement (TAVR) for aortic stenosis, aorto-cardiac fistula formation is recognized as a major complication. 9 Our patient was notable for lacking the typical inciting events that are usually known to cause these aorto-cardiac fistulas; without a history of trauma or infection, the fistula’s mechanism of formation was unclear. There was no obvious valvular endocarditis-like vegetation or obvious SOVA visualized by the CMR.…”

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 ). Prosthetic valve endocarditis can also be a cause ( 3 ).…”

“…However, patients with worsening heart failure symptoms should be considered for closure ( 2 ). Surgical correction is usually the gold standard, but enhanced operator experience with transcatheter approaches has promoted new techniques and devices for minimally invasive closure, especially given that many of these patients are poor surgical candidates ( 1 ).…”

Aorto-Right Ventricular Fistula and Paravalvular Leak After Transcatheter Aortic Valve Implantation

“…This paper reports the case of successful closure of aorto-RV fistula and PVL after TAVI using a VSD occluder device and 2 Amplatzer vascular plugs. A comprehensive search of published studies revealed only 12 cases of aorto-RV fistula following TAVR with high mortality rate ( Table 1 ) ( 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 ). All 4 patients who underwent percutaneous repair survived, and 3 of the other 8 cases managed conservatively died.…”