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Transcatheter Closure of Left Ventricular Outflow Tract-to-Left Atrium Fistula.

ABSTRACT: Surgical and rarely transcatheter aortic valve replacement can be complicated by intracardiac fistula. Transcatheter closure of those shunts has been previously reported with favorable results. We describe a case of percutaneous closure of left ventricular outflow tract-to-left atrium fistula after surgical aortic valve replacement using an Amplatzer Vascular Plug II. (Level of Difficulty: Advanced.).

SUBMITTER: Sammour Y

PROVIDER: S-EPMC8311196 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Case report: iatrogenic left ventricular outflow tract to right atrium fistula after trans-femoral transcatheter aortic valve implantation associated with asymmetric septal hypertrophy.

Project description:BackgroundThe transcatheter aortic valve implantation (TAVI) is becoming a leading treatment option for symptomatic aortic stenosis for patients in all surgical risk categories. Recognition and management of potential complications are essential to ensure patient life and comfort. We present here a case report of a left ventricular outflow tract (LVOT) to right atrium (RA) fistula which is an extremely rare complication after TAVI.Case summaryAn 85-year-old man with symptomatic severe aortic stenosis and non-obstructive asymmetric septal hypertrophy (ASH) underwent a transfemoral TAVI. Soon after the procedure, he developed chest pain and atrial fibrillation with rapid ventricular response. A transthoracic echocardiography followed by a transoesophageal echocardiography showed a small pseudo-aneurysm with a fistulous tract between the LVOT and the RA. This was confirmed by a contrast computed tomography scan of the heart. The patient remained asymptomatic throughout the rest of hospitalization. He was treated with diuretics and discharged home. One month follow-up showed increase in the width, jet size, and gradient of the fistula but the patient remained asymptomatic. The decision by Heart team was to closely monitor him for symptoms since the fistula is difficult to access percutaneously.DiscussionWe report a unique case of an LVOT to RA fistula in the setting of ASH that occurred post-TAVI. Alcohol septal ablation was proposed pre-TAVI for patients having septal thickening >15 mm and dynamic obstruction. Treatment options for iatrogenic fistula vary from symptomatic treatment to percutaneous or surgical closure.

| S-EPMC8184267 | biostudies-literature

Dynamic Left Ventricular Outflow Tract Obstruction Post-Transcatheter Aortic Valve Replacement.

Project description:We describe the first case of successful management of left ventricular outflow tract obstruction developing late after transcatheter aortic valve replacement with right ventricular apical pacing. The possible mechanisms of obstruction resolution are described. (Level of Difficulty: Advanced.).

| S-EPMC8311343 | biostudies-literature

Left Ventricular Outflow Tract Obstruction Following Transcatheter Mitral Valve Replacement Resolved by Chordal Rupture.

Project description:Transcatheter mitral valve replacement carries a risk of left ventricular outflow tract obstruction associated with mortality. We present a case of left ventricular outflow tract obstruction that resolved spontaneously when chords to the anterior mitral leaflet were found to have ruptured. (Level of Difficulty: Advanced.).

| S-EPMC8642730 | biostudies-literature

Impact of left ventricular outflow tract calcification in patients undergoing transfemoral transcatheter aortic valve implantation.

Project description:BackgroundLeft ventricular outflow tract (LVOT) calcification is known to be associated with adverse outcomes after transcatheter aortic valve implantation (TAVI) in patients receiving first-generation transcatheter heart valves (THV).AimsThe aim of the present study was to assess the prevalence of LVOT calcification as well as its impact on outcomes in a contemporary TAVI patient cohort.MethodsThis retrospective single-centre analysis includes 1,207 patients who underwent transfemoral TAVI between 2012 and 2018 and in whom adequate contrast-enhanced multislice computed tomgraphy (MSCT) imaging for quantification of LVOT calcification was available.ResultsSignificant LVOT calcification, defined as >10 mm3, was present in 37.4% (n=451) of the patient cohort. After applying propensity score matching there was no difference between patients without (w/o; n=358) and with (w; n=358) significant LVOT calcification with respect to baseline clinical characteristics. At 30 days, the composite of all-cause mortality and non-disabling/disabling stroke occurred more often in patients w LVOT calcification compared to those w/o (4.6 vs 10.1%, p=0.008). Moreover, the composite VARC-3 endpoint of device success at 30 days was in favour of patients w/o LVOT calcification (82.2% vs 73.4%, p=0.007). According to Kaplan-Meier analysis, all-cause mortality one year after TAVI was higher in patients w vs w/o LVOT calcification (12.9 vs 21.4 %, p=0.004).ConclusionsIn patients undergoing TAVI, the presence of significant LVOT calcification is common and associated with worse short-term clinical and functional outcomes as well as higher one-year mortality rates compared to patients w/o LVOT calcification.

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Unusual Cause of Left Ventricular Outflow Tract Obstruction Following Transcatheter Mitral Valve-in-Ring Replacement.

Project description: Not available

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Transcatheter Closure of Complex Left Circumflex to Coronary Sinus Fistula.

Project description:Coronary artery fistulae connecting the left circumflex to the coronary sinus are rare. Surgical closure of coronary sinus connections is technically challenging because of the location, especially in high-risk surgical patients. We used multimodality imaging to delineate the drainage site and successfully closed a left circumflex to coronary sinus fistula using a transcatheter closure technique. (Level of Difficulty: Advanced.).

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Transcatheter Closure of Aorta to Left Atrium Fistula during Active Prosthetic Valve Endocarditis as a Bridge for Surgery: A Case Report.

Project description: Not available

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Left ventricular outflow tract obstruction after transcatheter mitral valve replacement: a case report with a multifaceted approach.

Project description:An 83-year-old woman was admitted to our center because of heart failure. Transthoracic echocardiography revealed severe mitral annular calcification resulting in a double mitral valve lesion. After discussion by the heart team, transcatheter mitral valve replacement with Tendyne (Abbott Structural, Santa Clara, CA, USA) was performed. Despite having a predicted neo-left ventricular outflow tract (LVOT) above the cut-off value, the patient developed clinically significant LVOT obstruction (LVOTO) refractory to medical treatment. This situation is often treated before the intervention, and dealing with LVOTO afterward can be challenging. After taking the patient's anatomy into consideration, we decided to perform alcohol septal ablation. Applying a combined strategy of medical treatment and intervention led to success. In this case report, we discuss this event and the strategies available for preventing and managing the condition.

| S-EPMC11371709 | biostudies-literature

Innocent left ventricular outflow tract membrane masquerading as vegetation.

Project description:Innocent left ventricular outflow tract (LVOT) membranes are a rare entity and found incidentally on echocardiography. The authors report a case of innocent LVOT membrane in a patient who was admitted with ischaemic stroke. Initial transthoracic echocardiography showed a possible valvular vegetation which was thought to be the cause of embolic stroke. Anticoagulation with coumadin and antibiotics were started. Subsequent Transesophageal echocardiography showed that it was more consistent with innocent LVOT membrane and not vegetation. Anticoagulation and antibiotics were discontinued, and on a follow-up over 5 years later, the membrane was stable in size and location without any complications.

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Case report: Percoronary device closure of tortuous coronary artery fistula into left atrium.

Project description:Surgical ligation and transcatheter occlusion are the mainstream for the treatment of coronary artery fistulas (CAFs). However, these techniques applied to tortuous and aneurysmal CAF, especially those draining into left-heart, have their known drawbacks. We report, a successful percoronary device closure of such CAF, originating from left main coronary artery and draining into left atrium, through a left subaxillary minithoracotomy. Through a puncture on the distal straight course, we occluded CAF exclusively under transesophageal echocardiography guidance. Complete occlusion was achieved. It's a simple, safe, and effective alternative for tortuous, large, and aneurysmal CAFs draining into the left heart.

| S-EPMC9971947 | biostudies-literature

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