TRANSCATHETER CLOSURE OF LEFT VENTRICULAR OUTFLOW TRACT-TO-LEFT ATRIUM FISTULA AS A COMPLICATION OF BASILICA TAVR (BIOPROSTHETIC OR NATIVE AORTIC SCALLOP INTENTIONAL LACERATION TO PREVENT IATROGENIC CORONARY ARTERY OBSTRUCTION DURING TRANSCATHETER AORTIC VALVE REPLACMENT)
Recommended Citation
Fadel R, Kar Lok Lai L, Zweig B, Alrayes H, Fram G, Engel Gonzalez P, Lee JC, Frisoli TM, Villablanca PA, O’Neill BP. TRANSCATHETER CLOSURE OF LEFT VENTRICULAR OUTFLOW TRACT-TO-LEFT ATRIUM FISTULA AS A COMPLICATION OF BASILICA TAVR (BIOPROSTHETIC OR NATIVE AORTIC SCALLOP INTENTIONAL LACERATION TO PREVENT IATROGENIC CORONARY ARTERY OBSTRUCTION DURING TRANSCATHETER AORTIC VALVE REPLACMENT). J Am Coll Cardiol 2025; 85(12):2976.
Document Type
Conference Proceeding
Publication Date
4-1-2025
Publication Title
J Am Coll Cardiol
Keywords
aged, aortic regurgitation, aortic valve, balloon valvuloplasty catheter, case report, clinical article, complication, conference abstract, coronary occlusion, coronary stenosis, diagnosis, echocardiograph, echocardiography, female, fistula, heart left atrium, heart left ventricle outflow tract, hemodynamics, human, hypotension, laceration, left coronary cusp, male, mitral valve regurgitation, pericardial effusion, pericardiocentesis, scallop, surgery, transcatheter aortic valve implantation, very elderly
Abstract
Background: Left ventricular outflow tract (LVOT) perforation is not a widely recognized complication of BASILICA TAVR (Bioprosthetic Aortic Scallop Intentional Laceration to prevent Iatrogenic Coronary Artery obstruction during Transcatheter Aortic Valve Replacement). Case An 85-year-old female patient presented for valve-in-valve TAVR with BASILICA of a severely stenosed 23 mm bioprosthetic surgical valve. Under transesophageal echocardiogram (TEE) guidance, the left coronary cusp leaflet was lacerated, followed by surgical valve fracture using a 24 mm balloon valvuloplasty catheter. A 23 mm TAVR was subsequently deployed successfully with only trivial aortic regurgitation. The patient developed significant hypotension requiring vasopressor support. A significant LVOT-left atrium fistula was promptly identified on TEE, with severe mitral regurgitation, and a new pericardial effusion (figure 1). Decision-making An emergent pericardiocentesis was performed due to tamponade, with improvement in hemodynamics. Next, the decision was made to perform a transseptal puncture to facilitate closure of the fistula using a 10 mm VSD occluder device (figure 1). The decision was made to access the perforation through transseptal puncture due to its anterior location and freshly deployed TAVR valve. Conclusion Recognizing LVOT and mitral annular perforation as a complication of BASILICA TAVR is critical to prompt diagnosis and management. VSD occluder devices may be used in this setting. [Formula presented]
Volume
85
Issue
12
First Page
2976
