Pannus formation and iatrogenic ventricular septal defect after transcatheter aortic valve implantation.
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SUBMITTER: Li YJ
PROVIDER: S-EPMC9263154 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Transcatheter aortic valve implantation (TAVI) has been increasingly used in symptomatic patients with severe aortic stenosis who are at high risk for conventional open heart surgery. However, it might be associated with serious complications. We report a case with an iatrogenic ventricular septal defect as a rare complication following TAVI procedure. <Learning objective: To highlight a rare complication of iatrogenic ventricular septal defect (VSD) following transcatheter aortic valve implantation procedure and its treatment with percutaneous interventional VSD closure.>.
| S-EPMC6149284 | biostudies-literature
Project description:BackgroundA rare, but serious, complication following transcatheter aortic valve replacement (TAVR) is the occurrence of an iatrogenic ventricular septal defect (VSD).Case summaryWe describe a case of an 80-year-old female who was referred with severe aortic stenosis for TAVR. Following thorough evaluation, the heart team consensus was to proceed with implantation via a transapical approach of an ACURATE neo M 25 mm valve (Boston Scientific, Natick, MA, USA). The valve was deployed harnessing transoesophageal echocardiographic (TOE) guidance under rapid pacing with post-dilation. Directly afterwards a very high VSD close to the aortic annulus was detected. As the patient was haemodynamically stable, the procedure was ended. The next day another TOE revealed a shunt volume (left-to-right ventricle) between 50% and 60%. Because the defect was partly located between the stent struts of the ACURATE valve decision was made to fix this leakage with implantation of a further valve and we chose an EVOLUT Pro 29 mm (Medtronic Inc., Minneapolis, MN, USA). The valve-in-valve was implanted 2-3 mm below the lower edge of the first valve, more towards the left ventricular outflow tract (LVOT) with excellent result: VSD was reduced to a very small residual shunt without any hemodynamic relevance. Figure 3(A) Fluoroscopic image after transapical transcatheter aortic valve replacement (ACURATE neo M); (B) transoesophageal echocardiography following transapical transcatheter aortic valve replacement showing a severe ventricular septal defect; (C) angiography after valve-in-valve implantation. The implantation depth of the second valve (EVOLUT Pro 29 mm) was slightly deeper in the left ventricular outflow tract; and (D) transoesophageal echocardiography after the valve-in-valve procedure showing a small residual shunt. (1) Stentstruts, (2) tricuspid valve, and (3) leakage (ventricular septal defect). *Pulmonary artery catheter, #Pleural drain.Figure 4Left ventricular angiogram after valve-in-valve implantation showing a very small residual contrast shunt from the left-to-right ventricle (encircled). *Pulmonary artery catheter, # Pleural drain.DiscussionWe suggest that an iatrogenic VSD located near the annulus may be treated percutaneously in a bail-out situation with implantation of a second valve that should be implanted slightly more into the LVOT to cover the VSD.
| S-EPMC8117460 | biostudies-literature
Project description:Background:Iatrogenic membranous ventricular septal defects (VSDs) are rare complications of cardiothoracic surgery, such as septal myectomy for hypertrophic obstructive cardiomyopathy (HOCM). Transcatheter closure is considered an appealing alternative to surgery, given the increased mortality associated with repeated surgical procedures, but reports are extremely limited. Case summary:We herein report the case of a 63-year-old woman with HOCM who underwent successful percutaneous closure of an iatrogenic VSD after septal myectomy. Two percutaneous techniques are discussed, namely the 'muscular anchoring' and the 'buddy wire delivery', aimed at increasing support and providing stability to the system during percutaneous intervention. Discussion:Transcatheter closure represents an attractive minimally invasive approach for the management of symptomatic iatrogenic VSDs. The new techniques described could help operators to cross tortuous and tunnelled defects and to deploy closure devices in case of complex VSD anatomy.
| S-EPMC7319813 | biostudies-literature
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
Project description:BackgroundTranscatheter aortic valve implantation (TAVI) has proven efficacy in the treatment of aortic stenosis (AS). Understandably, there is increasing enthusiasm for its use to treat aortic regurgitation (AR). However, there are significant anatomical differences between AS and AR which make TAVI for AR more complex.Case summaryWe present the case of technically challenging TAVI for severe AR, which was complicated by a traumatic ventricular septal defect (VSD) that required percutaneous closure. To our knowledge, this is the first published case of VSD post-TAVI for AR.DiscussionThis unanticipated complication highlights anatomical differences between TAVI use in AS and AR. Lack of aortic valve calcification and excessive annular compliance made stable deployment of a self-expanding valve extremely challenging. Despite device oversizing, repeated embolization of the prosthesis into the left ventricular outflow tract traumatized the interventricular septum.
| S-EPMC8564692 | biostudies-literature
Project description:Iatrogenic valvular regurgitation following cardiac surgery has been reported as a result of leaflet perforation or entrapment. Due to its central location, the aortic valve is one of the most vulnerable structures for iatrogenic injuries. Proper assessment of the aortic valve by transesophageal echocardiography (TEE) should be done after a cardiac surgery in the periaortic area. We hereby report a case of iatrogenic aortic regurgitation which was developed after primary closure of perimembranous ventricular septal defect. It was timely diagnosed by TEE after termination of cardiopulmonary bypass and helped in further management.
| S-EPMC7034207 | biostudies-literature
Project description: Not available
| S-EPMC9007440 | biostudies-literature
Project description:BackgroundClosure of perimembranous ventricular septal defects (pmVSD), either surgical or percutaneous, might improve or cause new-onset mitral regurgitation (MR) and aortic regurgitation (AR). We aimed to evaluate the changes in MR and AR after pmVSD closure by these two methods.Material and methodWe performed a comparative retrospective data review of all pediatric patients with pmVSDs treated at our institution with surgical or antegrade percutaneous methods from 2014 to 2019 and 146 consecutive patients under 18 years were enrolled. We closely looked at the mitral and aortic valve function after repair. Included patients had no or lower than moderate aortic valve prolapse and baseline normal mitral or aortic valve function or less than moderate MR or AR.ResultsOut of 146 patients, 83 (57%) pmVSDs were closed percutaneously, and 63 (43%) pmVSDs were closed surgically. 80 and 62 patients were included for MR evaluation, and 81 and 62 patients for AR evaluation in percutaneous and surgical groups. The mean follow-up time was 40.48 ± 21.59 months in the surgery group and 20.44 ± 18.66 months in the transcatheter group. Mild to moderate degrees of MR and AR did not change or decreased in most patients. In detail, MR of 70% and AR of 50% of the valves were resolved or decreased in both groups. 13% of patients with no MR developed trivial to mild MR, and 10% of patients with no AR showed mild to moderate AR after pmVSD closure in both methods. There was no significant difference between the two methods regarding emerging new regurgitation or change in the severity of the previous regurgitation.ConclusionpmVSD closure usually improves mild to moderate MR and AR to a nearly similar extent in both percutaneous and surgical methods among children and adolescents. It might lead to the onset of new MR or AR in cases with no regurgitation.
| S-EPMC9287911 | biostudies-literature
Project description:Previous studies have identified an increased incidence of bicuspid aortic valve (BAV) in patients with ventricular septal defect (VSD). Because endocardial cushion remodeling contributes to both the formation of semilunar valves and ventricular septation, we hypothesized that examination of humans with BAV and VSD would identify a specific VSD type. We evaluated VSD type in pediatric patients diagnosed with BAV and VSD (n=82) and compared findings to patients diagnosed with VSD and normal aortic valve morphology (n=429). VSD type was described as conoventricular, muscular, inlet or conoseptal using a clinical taxonomy. Based on the contribution of the outflow tract endocardial cushions to the membranous ventricular septum, we expected patients with BAV to have conoventricular VSD. In both patient groups, conoventricular VSD was most common; however, the prevalence was not significantly different when BAV patients were compared to those with normal aortic valve morphology (67% vs. 57%, P=0.11). The primary finding of this study is that despite a developmental link between semilunar valve formation and ventricular septation during cardiogenesis, there is no clear association between BAV and VSD type. This may be due to phenotypic and genetic heterogeneity of BAV and VSD, other modifying factors as manifested by differences in associated CVM, as well as limitations of the clinical taxonomy of VSD.
| S-EPMC2644069 | biostudies-literature
Project description:Background: The outcome of redo transcatheter aortic valve (TAV) implantation (TAVI) is unknown for TAV structural valve degeneration (SVD). This paper reports the initial results of redo TAVI for TAV-SVD in Japanese patients. Methods and Results: Of 630 consecutive patients, 6 (1.0%) underwent redo TAVI for TAV-SVD (689-1,932 days after the first TAVI). The first TAV were 23-mm balloon-expandable valves (BEV, n=5) and a 26-mm self-expandable valve (SEV, n=1). All patients underwent multidetector computed tomography (MDCT) before redo TAVI, which showed first-TAV under-expansion (range, 19.1-21.0 mm) compared with the label size. Two BEV and 4 SEV were successfully implanted as second TAV, without moderate/severe regurgitation or 30-day mortality. One of 2 patients with a BEV-inside-BEV implantation had a high transvalvular mean pressure gradient post-procedurally (34 mmHg) and required surgical valve replacement 248 days after the redo TAVI. This, however, was unnoted in patients with SEV implantation during redo TAVI. Planned coronary artery bypass grafting was concomitantly performed in 1 patient with a small sino-tubular junction and SEV-inside-SEV implantation because of the risk of coronary malperfusion caused by the first TAV leaflets. Five of the 6 patients survived during the follow-up period (range, 285-1,503 days). Conclusions: Redo TAVI for TAV-SVD appears safe and feasible, while specific strategies based on MDCT and device selection seem important for better outcomes.
| S-EPMC7890286 | biostudies-literature