Transcatheter Closure of an LVOT to LA Fistula After Aortic Bioprosthetic Valve Fracture.

BACKGROUND

Left ventricular outflow tract to left atrium (LVOT-LA) fistula is an uncommon but serious complication of transcatheter aortic valve replacement (TAVR), associated with adverse clinical outcomes.

CASE SUMMARY: A 78-year-old man with a history of surgical aortic valve replacement, followed by valve-in-valve TAVR, presented with significant dyspnea thought to be due to a valve-in-valve patient prosthesis mismatch. He underwent valve fracture of the TAVR valve. Post-balloon valvuloplasty, the patient developed an LVOT-LA fistula. He presented with worsening exertional dyspnea. Transesophageal echocardiography confirmed the fistula, and a percutaneous transvenous closure using an Amplatzer IV vascular plug was successfully performed. After the procedure, the patient's symptoms markedly improved.

DISCUSSION: Percutaneous closure of an LVOT-LA fistula is technically feasible when performed in experienced centers. Small, low-profile occlusion devices, such as the Amplatzer IV vascular plug, are preferred to minimize the risk of interference with adjacent valvar structures.

TAKE-HOME MESSAGES: Intracardiac shunts are uncommon but serious complications of TAVR. Percutaneous closure is technically feasible when performed at experienced centers.