Treatment of an unusual complication of transfemoral TAVI with a new technique : successful occlusion of ventricular septal defect by opening the closure device in the ascending aorta : case report

Abstract

Ventricular septal defect (VSD) is a rare complication of transcatheter aortic valve implantation (TAVI) via the transfemoral approach. Aetiological factors leading to VSD have been reported as post-balloon dilatation, oversized prosthesis implantation, and severe calcification of the aorta. However, we present a case of VSD occurring after TAVI with an Edwards Sapien XT prosthesis without any distinct aetiological factors. We used a new technique for closure of the significant VSD; opening the left ventricular disc of the closure device in the ascending aorta and successfully implanting the device without any damage to the bioprosthetic valve.

Injuries to the Aorta, Aortic Annulus, and Left Ventricle During Transcatheter Aortic Valve Replacement

“…51,[54][55][56] If the VSD is symptomatic and requires intervention, percutaneous closure should be the first option given the high-risk TAVR patient population and the high success rate and low incidence of complications associated with percutaneous closure. [57][58][59][60][61][62][63] In the only review published to date, 4 of the 20 patients (20%) died; however, there were no deaths among the patients who underwent VSD closure, and all were clinically stable at a median follow-up of 7.5 months. 51 Most post-TAVR VSDs are located close to the prosthetic valve, and it has been hypothesized that percutaneous closure devices could interfere with valve function or displace the valve itself.…”

Percutaneous closure of an iatrogenic ventricular septal defect following transcatheter aortic valve implantation

“…The majority (75%) of post-TAVI VSDs were reported after balloon expandable valves (e.g. Edwards-Sapien devices) and pre-or post-dilatation was performed in most of the cases [1][2][3], also in our case post-dilatation was performed during the TAVI procedure. The iatrogenic VSD following TAVI procedure might be the result of (1) excessive aortic calcification which lacerates the interventricular septum during pre-or post-dilatation of the stenotic aortic valve and/or (2) or direct damage of the intraventricular septum during the post-dilatation of the valve.…”

“…TAVI revolutionized the management of valvular aortic stenosis by providing a safe and efficacious alternative to surgical valve replacement in higher-risk patients. Iatrogenic VSD is a rare complication following conventional surgical valve replacement and transcatheter closure of such defects with various occluder devices is described in the literature [1][2][3][4]. To date only 20 cases of iatrogenic VSD following TAVI procedure are published and only few of them were treated with a transcatheter interventional approach [1][2][3].…”

Iatrogenic Ventricular Septal Defect Following Transcatheter Aortic Valve Replacement: A Systematic Review

“…The 18 articles were all case reports and included 20 patients [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] (Table 1). The median age was 86-yearsold (range 57-89) and six were male.…”

“…Second, dislodgement of the valve in the process of delivering the VSD closure device is possible, especially in the retrograde technique. There were three cases where a retrograde technique was utilised for VSD closure device delivery but none reported technical difficulty [22,28,29].…”