Left Ventricular Pseudoaneurysm to Coronary Sinus Fistula Treated With an Occluding Device

Hybrid Transcatheter Approach to an Iatrogenic Left Ventricle–Coronary Sinus Fistula

“…It has been described only 3 times in the available literature, twice using a vascular plug, once with ventricular septal defect occluders, and all using access through the CS. 1 , 2 , 3 To our knowledge, this is the first case of an LV-CS fistula treated percutaneously through a hybrid transapical approach.…”

“…Acquired LV-CS fistula is a rare complication of intracardiac procedures, with documented occurrences after MVR, myocardial infarction, and catheter ablation. 1 , 2 , 3 , 4 The risk of fistula formation after mitral valve surgery increases with the number of interventions, damage to the posterior ventricular wall, and excessive debridement of the mitral valve annulus. 5 That last factor is particularly relevant in this patient with rheumatic valvular disease because intraoperatively, the degree of pannus and tissue friability around the annulus required significant debridement to allow adequate seating of the prostheses.…”

Transcatheter Closure of Left Ventricle to Coronary Sinus Fistula Post-MVR and Septal Myectomy

“…Multiple mitral valve surgeries, excessive debridement of the mitral valve annulus, or injury to the posterior wall are believed to increase the risk of fistula development. Most reported cases have required surgical repair ( 3 ), whereas 1 limited case report described closure of an LV pseudoaneurysm to CS fistula by percutaneous placement of 2 ventricular septal occluders ( 8 ).…”