Pannus formation and iatrogenic ventricular septal defect after transcatheter aortic valve implantation.
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ABSTRACT:
SUBMITTER: Li YJ
PROVIDER: S-EPMC9263154 | biostudies-literature | 2022 Jul
REPOSITORIES: biostudies-literature
Publications
Pannus formation and iatrogenic ventricular septal defect after transcatheter aortic valve implantation.
Li Yan-Jie YJ Pan Xin X Ma Lan L He Ben B
European heart journal. Case reports 20220628 7
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Project description:Transcatheter aortic valve implantation (TAVI) has been increasingly used in symptomatic patients with severe aortic stenosis who are at high risk for conventional open heart surgery. However, it might be associated with serious complications. We report a case with an iatrogenic ventricular septal defect as a rare complication following TAVI procedure. <Learning objective: To highlight a rare complication of iatrogenic ventricular septal defect (VSD) following transcatheter aortic valve implantation procedure and its treatment with percutaneous interventional VSD closure.>.
| S-EPMC6149284 | biostudies-literature
Project description:Ventricular septal defect (VSD) rarely occurs following transcatheter aortic valve implantation (TAVI). We report two patients who developed VSD following TAVI. One case was a Gerbode defect treated by percutaneous closure, and the second was a restrictive perimembranous VSD managed conservatively.
| S-EPMC9762799 | biostudies-literature
Project description:BackgroundA rare, but serious, complication following transcatheter aortic valve replacement (TAVR) is the occurrence of an iatrogenic ventricular septal defect (VSD).Case summaryWe describe a case of an 80-year-old female who was referred with severe aortic stenosis for TAVR. Following thorough evaluation, the heart team consensus was to proceed with implantation via a transapical approach of an ACURATE neo M 25 mm valve (Boston Scientific, Natick, MA, USA). The valve was deployed harnessing transoesophageal echocardiographic (TOE) guidance under rapid pacing with post-dilation. Directly afterwards a very high VSD close to the aortic annulus was detected. As the patient was haemodynamically stable, the procedure was ended. The next day another TOE revealed a shunt volume (left-to-right ventricle) between 50% and 60%. Because the defect was partly located between the stent struts of the ACURATE valve decision was made to fix this leakage with implantation of a further valve and we chose an EVOLUT Pro 29 mm (Medtronic Inc., Minneapolis, MN, USA). The valve-in-valve was implanted 2-3 mm below the lower edge of the first valve, more towards the left ventricular outflow tract (LVOT) with excellent result: VSD was reduced to a very small residual shunt without any hemodynamic relevance. Figure 3(A) Fluoroscopic image after transapical transcatheter aortic valve replacement (ACURATE neo M); (B) transoesophageal echocardiography following transapical transcatheter aortic valve replacement showing a severe ventricular septal defect; (C) angiography after valve-in-valve implantation. The implantation depth of the second valve (EVOLUT Pro 29 mm) was slightly deeper in the left ventricular outflow tract; and (D) transoesophageal echocardiography after the valve-in-valve procedure showing a small residual shunt. (1) Stentstruts, (2) tricuspid valve, and (3) leakage (ventricular septal defect). *Pulmonary artery catheter, #Pleural drain.Figure 4Left ventricular angiogram after valve-in-valve implantation showing a very small residual contrast shunt from the left-to-right ventricle (encircled). *Pulmonary artery catheter, # Pleural drain.DiscussionWe suggest that an iatrogenic VSD located near the annulus may be treated percutaneously in a bail-out situation with implantation of a second valve that should be implanted slightly more into the LVOT to cover the VSD.
| S-EPMC8117460 | biostudies-literature
Project description: Not available
| S-EPMC6177075 | biostudies-literature
Project description:BackgroundIatrogenic membranous ventricular septal defects (VSDs) are rare complications of cardiothoracic surgery, such as septal myectomy for hypertrophic obstructive cardiomyopathy (HOCM). Transcatheter closure is considered an appealing alternative to surgery, given the increased mortality associated with repeated surgical procedures, but reports are extremely limited.Case summaryWe herein report the case of a 63-year-old woman with HOCM who underwent successful percutaneous closure of an iatrogenic VSD after septal myectomy. Two percutaneous techniques are discussed, namely the 'muscular anchoring' and the 'buddy wire delivery', aimed at increasing support and providing stability to the system during percutaneous intervention.DiscussionTranscatheter closure represents an attractive minimally invasive approach for the management of symptomatic iatrogenic VSDs. The new techniques described could help operators to cross tortuous and tunnelled defects and to deploy closure devices in case of complex VSD anatomy.
| S-EPMC7319813 | biostudies-literature
Project description: Not available
| S-EPMC7954272 | biostudies-literature
Project description:BackgroundThe 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 summaryAn 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.DiscussionWe 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.
| S-EPMC8184267 | biostudies-literature
Project description:BackgroundPrevious reports suggest septal hypertrophy with an interventricular septum depth (IVSD) ≥ 14 mm may adversely affect outcomes after transcatheter aortic valve implantation (TAVI) due to suboptimal valve placement, valve migration, or residual increased LVOT pressure gradients.AimsThis analysis investigates the impact of interventricular septal hypertrophy on acute outcomes after TAVI.MethodsBetween 2009 and 2021, 1033 consecutive patients (55.8% male, 80.5 ± 6.7 years, EuroSCORE II 6.3 ± 6.5%) with documented IVSD underwent TAVI at our center and were included for analysis. Baseline, periprocedural, and 30-day outcome parameters of patients with normal IVSD (< 14 mm; group 1) and increased IVSD (≥ 14 mm; group 2) were compared. Data were retrospectively analyzed according to updated Valve Academic Research Consortium-3 (VARC-3) definitions. Comparison of outcome parameters was adjusted for baseline differences between groups using logistic and linear regression analyses.ResultsOf 1033 patients, 585 and 448 patients were allocated to groups 1 and 2, respectively. There was no significant difference between groups regarding transfemoral access rate (82.6% (n = 478) vs. 86.0% (n = 381), p = 0.157). Postprocedural mean transvalvular pressure gradient was significantly increased in group 2 (group 1, 7.8 ± 4.1 mmHg, vs. group 2, 8.9 ± 4.9 mmHg, p = 0.046). Despite this finding, there was no significant difference between groups regarding the rates of VARC-3 adjudicated composite endpoint device success (90.0% (n = 522) vs. 87.6% (n = 388), p = 0.538) or technical success (92.6% (n = 542) vs. 92.6% (n = 415), p = 0.639). Moreover, the groups showed no significant differences regarding the rates of paravalvular leakage ≥ moderate (3.1% (n = 14) vs. 2.6% (n = 9), p = 0.993), postprocedural permanent pacemaker implantation (13.4% (n = 77) vs. 13.8% (n = 61), p = 0.778), or 30-day mortality (5.1% (n = 30) vs. 4.5% (n = 20), p = 0.758).ConclusionAlthough transvalvular mean pressure gradients were significantly higher in patients with increased IVSD after TAVI, acute outcomes were comparable between groups suggesting no early impact of adverse hemodynamics due to elevated IVSD. However, how these differences in hemodynamic findings may affect mid- and long-term outcomes, especially in terms of valve durability, needs to be evaluated in further investigations.
| S-EPMC11914327 | biostudies-literature
Project description: Not available
| S-EPMC10264201 | biostudies-literature
Project description:BackgroundTranscatheter aortic valve implantation (TAVI) has proven efficacy in the treatment of aortic stenosis (AS). Understandably, there is increasing enthusiasm for its use to treat aortic regurgitation (AR). However, there are significant anatomical differences between AS and AR which make TAVI for AR more complex.Case summaryWe present the case of technically challenging TAVI for severe AR, which was complicated by a traumatic ventricular septal defect (VSD) that required percutaneous closure. To our knowledge, this is the first published case of VSD post-TAVI for AR.DiscussionThis unanticipated complication highlights anatomical differences between TAVI use in AS and AR. Lack of aortic valve calcification and excessive annular compliance made stable deployment of a self-expanding valve extremely challenging. Despite device oversizing, repeated embolization of the prosthesis into the left ventricular outflow tract traumatized the interventricular septum.
| S-EPMC8564692 | biostudies-literature