A 90-year-old patient was admitted to our hospital for a transfemoral aortic valve implantation (TAVI) because of symptomatic severe aortic stenosis.A 29-mm Edwards SAPIEN valve was implanted during an uncomplicated procedure. However, routine post-TAVI transthoracic echocardiography revealed a fistula from the aorta to the right ventricular outflow tract (RVOT) (see Supplementary material online, Video S1). This fistula was confirmed by cardiac CT. During a week of observation, our patient was asymptomatic, without any signs of right sided heart failure or rhythm disturbances other than a non-sustained ventricular tachycardia. However, based on the poor prognosis of traumatic aortic fistulas, we proceeded to fistula closure. After review by our heart team, a decision was made to proceed with percutaneous closure using an Amplatzer septal occlude device.Through the left femoral artery, a guiding wire was inserted in the fistula, and an Amplatzer device was placed guided by angiography and echocardiography. Amplatzer sizing was determined using echocardiography. The distal part of the Amplatzer was placed in the RVOT, the body in the fistula, and the proximal part on the top edge of the Edwards SAPIEN valve (see Supplementary material online, Video S2). Coronary angiography revealed a patent right coronary artery (see Supplementary material online, Video S3), and post-procedural angiography demonstrated absence of the aortic shunt or aortic regurgitation (Figure , Supplementary material online, Video S4a). This was confirmed by echocardiography (see Supplementary material online, Video S4b). Our patient was discharged in a good condition.
Figure 1
Angiography demonstrated absence of the aorta-right ventricular fistula or aortic regurgitation.
Angiography demonstrated absence of the aorta-right ventricular fistula or aortic regurgitation.
Supplementary material
Supplementary material is available at European Heart Journal - Case Reports online.Consent: The author/s confirm that written consent for submission and publication of this case report including image(s) and associated text has been obtained from the patient in line with COPE guidance.Conflict of interest: none declared.Click here for additional data file.Click here for additional data file.Click here for additional data file.Click here for additional data file.Click here for additional data file.Click here for additional data file.Click here for additional data file.
Figure 1