title: Transcatheter closure of an iatrogenic ventricular septal defect after SAPIEN valve implantation.
abstract: A 57-year-old woman developed progressive calcific mitral and aortic valve disease with a porcelain aorta secondary to a history of radiation therapy. She was considered a very poor operative candidate and referred for transcatheter aortic valve replacement (TAVR). Four weeks after extensive coronary artery stenting, a TAVR was performed with a 23 mm Edwards SAPIEN valve (Edwards Life Sciences, Irvine, CA) through a transapical approach. Post-operatively, her symptoms of dyspnea persisted and worsened. She was found to have an acquired ventricular septal defect (VSD) measuring 8 mm by 5 mm by transesophageal echocardiogram and by a CT angiogram. Percutaneous VSD closure was accomplished with an 8 mm Muscular VSD Occluder (St. Jude Medical, St. Paul, MN) with elimination of her shunt, improvement of her dyspnea, and marked improvement in exercise tolerance.
authors.affiliation: Division of Pediatric Cardiology, Mattel Children's Hospital at UCLA, Los Angeles, California.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Levi
authors.forename: Morris
authors.initials: M
authors.lastname: Salem
authors.forename: William
authors.initials: W
authors.lastname: Suh
mesh_terms: D001021:Aortic Valve / Q000473:pathology* / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D002114:Calcinosis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D017023:Coronary Angiography / Q000379:methods; D017548:Echocardiography, Transesophageal; D005260:Female; D006335:Heart Injuries / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D007049:Iatrogenic Disease; D008875:Middle Aged; D011474:Prosthesis Design; D020127:Recovery of Function; D055989:Septal Occluder Device; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D054088:Ventricular Septum / Q000293:injuries
keywords: TAVR; VSD; amplazter; aortic