Case report: iatrogenic left ventricular outflow tract to right atrium fistula after trans-femoral transcatheter aortic valve implantation associated with asymmetric septal hypertrophy
| Autor: | Martine Gilard, Thomas Hebert, Romain Didier, Ahmad Al Ayouby |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Alcohol septal ablation Post-TAVI complications LVOT to RA fistula business.industry Fistula Atrial fibrillation 030204 cardiovascular system & hematology Chest pain medicine.disease Asymptomatic Surgery 03 medical and health sciences Stenosis 0302 clinical medicine Aortic valve stenosis Case report Asymmetric septal hypertrophy medicine Ventricular outflow tract AcademicSubjects/MED00200 030212 general & internal medicine medicine.symptom Cardiology and Cardiovascular Medicine business |
| Zdroj: | European Heart Journal: Case Reports |
| ISSN: | 2514-2119 |
| DOI: | 10.1093/ehjcr/ytab020 |
| Popis: | Background The 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 summary An 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. Discussion We 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. |
| Databáze: | OpenAIRE |
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