Romain Didier, MD from the Department of Cardiology, University Hospital of Brest speaks about Case Report: Iatrogenic Left Ventricular Outflow Tract To Right Atrium Fistula After Trans-femoral Transcatheter Aortic Valve Implantation Associated With Asymmetric Septal Hypertrophy.
Link to Article:
TAVI (transcatheter aortic valve implantation) is quickly becoming a popular therapeutic option for symptomatic aortic stenosis in patients with all surgical risk levels. To guarantee the patient's life and comfort, it's critical to recognize and manage any problems. A left ventricular outflow tract (LVOT) to right atrium (RA) fistula, an extremely uncommon complication following TAVI, is described here.
Summary of the case:
A transfemoral TAVI was performed on an 85-year-old man with symptomatic severe aortic stenosis and non-obstructive asymmetric septal hypertrophy (ASH). He had chest discomfort and atrial fibrillation with a fast ventricular response shortly after the operation. A tiny pseudo-aneurysm with a fistulous tract between the LVOT and the RA was discovered on a transthoracic echocardiogram followed by transoesophageal echocardiography. A contrast computed tomography scan of the heart verified this. Throughout the duration of the stay, the patient was asymptomatic. Diuretics were given to him and he was sent home. The breadth, jet size, and gradient of the fistula increased with time, but the patient remained asymptomatic. Because the fistula is difficult to reach percutaneously, the Heart team decided to keep a careful eye on him for symptoms.
We present a one-of-a-kind instance of a post-TAVI LVOT to RA fistula in the setting of ASH. Pre-TAVI alcohol septal ablation was suggested for individuals with septal thickness more than 15 mm with dynamic blockage. Iatrogenic fistula treatment options range from symptomatic relief to percutaneous or surgical closure.