title: Percutaneous closure of acute aorto-right ventricular fistula following transcatheter bicuspid aortic valve replacement.
abstract: We report a case of acute aorto-right ventricular fistula following transcatheter bicuspid aortic valve replacement and subsequent percutaneous closure. The diagnosis and treatment of this rare complication is illustrated through multi-modality imaging. We hypothesize that the patient's heavily calcified bicuspid aortic valve anatomy led to asymmetric deployment of the transcatheter aortic valve replacement (TAVR) prosthesis, traumatizing the right sinus of Valsalva at the distal edge of the TAVR stent and ultimately fistulized to the right ventricle. The patient acutely decompensated with heart failure five days after TAVR and underwent emergent intervention. The aorto-right ventricular fistula was closed using an 18-mm septal occluder device with marked clinical recovery. Transcatheter closure is a viable treatment option for acute aorto-right ventricular fistula. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Kenta
authors.initials: K
authors.lastname: Nakamura
authors.affiliation: Interventional Echocardiography, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Passeri
authors.affiliation: Adult Congenital Heart Disease Interventions, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Inglessis-Azuaje
mesh_terms: D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D001021:Aortic Valve / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D001027:Aortography / Q000379:methods; D000082882:Bicuspid Aortic Valve Disease; D006328:Cardiac Catheterization / Q000295:instrumentation; D000072226:Computed Tomography Angiography; D018618:Echocardiography, Doppler, Color; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D006331:Heart Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D006333:Heart Failure / Q000209:etiology; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D055989:Septal Occluder Device; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects* / Q000295:instrumentation; D016896:Treatment Outcome; D016157:Vascular Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*
keywords: aortic valve disease; fistula; percutaneous intervention; shunts; transcatheter valve implantation