Aorto-right ventricular fistula after transfemoral aortic valve implantation.
ABSTRACT A 91-year-old female patient presented with worsening exertional dyspnea 1 month after transfemoral aortic valve implantation using an Edwards Sapien valve. She was found to have a paraprosthetic sinus of Valsalva rupture with a left-to-right shunt into the right ventricular cavity. The patient underwent coil closure of the defect with successful shunt elimination.
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ABSTRACT: Transcatheter aortic valve replacement (TAVR) techniques are rapidly evolving, and results of published trials suggest that TAVR is emerging as the standard of care in certain patient subsets and a viable alternative to surgery in others. As TAVR is a relatively new procedure and continues to gain its acceptance, rare procedural complications will continue to appear. Our case is about an 89-year-old male with extensive past medical history who presented with progressive exertional dyspnea and angina secondary to severe aortic stenosis. Patient got TAVR and his postoperative course was complicated by complete heart block, aorto-RV fistula, and ventricular septal defect (VSD) formation as a complication of TAVR. To the best of our knowledge, this is the third reported case of aorto-RV fistula following TAVR as a procedural complication but the first one to show three complications all together in one patient.01/2015; 2015:608539. DOI:10.1155/2015/608539
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ABSTRACT: Aortocardiac fistulas are rare, especially if they develop after an aortic valve replacement surgery. We report the case of a 54-year-old male submitted to aortic valve replacement and implantation of an ascending aortic prosthetic graft, complaining of exertional dyspnea, who was found to have significant shunt between the aortic root and right ventricle (RV), and de novo moderate pulmonary hypertension. At the catheterization laboratory, the left-to-right shunt was confirmed (Qp:Qs = 1.9:1). Contrast angiography of the ascending aorta showed a significant flow into the right ventricular cavity, and the fistulous tract was then measured, inflating a Tyshak II balloon of 10 × 20 mm (NuMED, Hopkinton, New York), until achieving a complete interruption of flow. Minimal diameter of the defect was 4.9 mm. Percutaneous closure of the aorto-RV shunt was performed under general anesthesia and transesophageal echocardiogram and fluoroscopic guidance. Using a venous and an arterial femoral access, a 0.035″ hydrophilic guide-wire crossed the defect between the aorta and RV, creating an arteriovenous loop. Then, using a 7F Delivery System 45° (AGA medical corporation, Golden Valley, MN) an Amplatzer Duct Occluder(®) (AGA Medical Corporation) 8/6 mm was advanced and released within the defect, achieving an almost complete closure of the fistulous tract.Catheterization and Cardiovascular Interventions 02/2012; 79(3):448-52. DOI:10.1002/ccd.23222 · 2.40 Impact Factor
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital 01/2011; 38(6):728-9. · 0.63 Impact Factor