Aorto-right ventricular fistula after transfemoral aortic valve

Article · February 2010with28 Reads
Source: PubMed
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.
    • Aortic dissection that had caused an aorto-right ventricular fistula has been also reported in the literature [5]. Recently, the formation of such a fistula as a complication of transcatheter aortic valve implantation has been reported, indicating erosion by the mechanical prosthetic valve struts as the possible mechanism for the fistula formation [6]. The clinical presentation of an aorto-right ventricular fistula depends on its etiology, as well as on the size of the shunt.
    [Show abstract] [Hide abstract] ABSTRACT: The occurrence of aorto-right ventricular fistula after aortic valve replacement is rare. If remains untreated, the condition could result in heart failure and therefore significantly compromise patients’ survival. Surgical closure comprises the treatment of choice; however, transcatheter closure has been attempted, with relatively acceptable results. We report on a patient with an aorto-right ventricular fistula present for nine years, after aortic valve replacement, who presented with heart failure. Successful transcatheter closure of the fistula with the use of the Amplatzer duct occluder was performed, suggesting the percutaneous approach as an efficient technique for the treatment of such fistulae.
    Full-text · Article · Jun 2016
    • The most common iatrogenic causes for ARV fistulas are aortic valve replacement and to a lesser degree type A aortic dissection repair [4,5]. Few cases have been reported post transfemoral aortic valve implanatation (TAVI) [6]. A well recognized rare cause of ARV fistula is rupture of sinus of valsalva aneurysms whether congenital or acquired [7].
    Full-text · Article · May 2016 · Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital
    • Indeed, ARV fistula may follow either surgical aortic valve replacement [1, 15] or percutaneous aortic valve implantation (TAVI) [16] . Several mechanisms may lead to cardiac shunts during aortic valve surgery including unintentional injury to the membranous septum sustained during dissection below the noncoronary cusps, perivalvular damage attributable to improper retraction and excessive and aggressive debridement of bulky areas of calcification from the aortic annulus567891011121314151617 and/or pseudo-aneurysm formation secondary to degenerative changes at the aortotomy line and the pseudo-aneurysm's eventual rupture into the RV [1] . Lorenz et al. proposed ischemic necrosis because of inappropriate suturing of the mechanical valve if the membranous portion of the ventricular septum is included in the prosthetic valve suture line [5] .
    [Show abstract] [Hide abstract] ABSTRACT: The implantation of prosthetic heart valves has been associated with several kinds of complications, but the description of aorto-right ventricle (ARV) fistula as a complication of aortic valve replacement is a very rare finding. We report herein the case of a 56-year-old woman sought care for palpitations two months after prosthetic aortic and mitral valve replacement. Cardiac examination revealed normally audible mechanical sounds with a new loud to-and-fro murmur with continuous precordial thrill. Thyroid function tests were poorly balanced (raised FT4 and lowered TSH). Electrocar-diography at admission displayed rapid heart rhythm with atrial fibrillation. Trans-thoracic echocardiography (TTE) revealed left-to-right shunt due to aorto-RV fistula. We discuss then the aetiology, diagnosis and management of this rare para-valvular leakage.
    Full-text · Article · Dec 2015
    • As TAVR is a relatively new procedure and continues to gain its acceptance, rare procedural complications will continue to appear [2] . Aortoright ventricular (aorto-RV) fistula has been reported as a complication of aortic valve replacement surgery but to the best of our knowledge there are only a couple of case reports with TAVR [3]. We report a case with complete heart block, aorto-RV fistula, and ventricular septal defect (VSD) formation as a complication of TAVR.
    [Show abstract] [Hide abstract] 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.
    Full-text · Article · Apr 2015
  • [Show abstract] [Hide abstract] ABSTRACT: Surgical aortic valve replacement (SAVR) is the only treatment known to improve symptoms and survival in patients with severe, symptomatic aortic stenosis. Perioperative mortality, however, is high among many patients for whom SAVR may be indicated. Percutaneous heart valve replacement (PHVR) is an emerging, catheter-based technology that allows for implantation of a prosthetic valve without open heart surgery. This review describes the available literature on PHVR for aortic stenosis, which comprised 84 published reports representing 76 distinct studies and 2375 unique patients. Successful implantation was achieved in 94% of patients; 30-day survival was 89%. Differences between patients undergoing PHVR and those typically selected for SAVR make full interpretation of these results difficult. A large, multicenter, randomized, controlled trial comparing PHVR with SAVR or medical management was recently completed, with initial results expected in September 2010. Pending publication of findings from that trial, the available evidence is inadequate to determine the most appropriate clinical role of PHVR or the specific patient populations for whom it might eventually be indicated.
    Full-text · Article · Sep 2010
  • Full-text · Article · Dec 2011
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