Cargando…

Complex cardiac surgery in a high-risk patient with new-onset severe mitral regurgitation and aorta to right ventricular fistula after transcatheter aortic valve implantation: a case report

BACKGROUND: Transcatheter aortic valve implantation (TAVI) is the procedure of choice for aortic stenosis in high surgical risk patients, but it is no free from complications. CASE SUMMARY: A 86-year-old patient with severe aortic stenosis underwent TAVI 3 years ago with an Edwards Sapiens valve by...

Descripción completa

Detalles Bibliográficos
Autores principales: Verdugo-Marchese, Mario, Monney, Pierre, Muller, Olivier, Kirsch, Matthias
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7649498/
https://www.ncbi.nlm.nih.gov/pubmed/33204983
http://dx.doi.org/10.1093/ehjcr/ytaa206
_version_ 1783607341505052672
author Verdugo-Marchese, Mario
Monney, Pierre
Muller, Olivier
Kirsch, Matthias
author_facet Verdugo-Marchese, Mario
Monney, Pierre
Muller, Olivier
Kirsch, Matthias
author_sort Verdugo-Marchese, Mario
collection PubMed
description BACKGROUND: Transcatheter aortic valve implantation (TAVI) is the procedure of choice for aortic stenosis in high surgical risk patients, but it is no free from complications. CASE SUMMARY: A 86-year-old patient with severe aortic stenosis underwent TAVI 3 years ago with an Edwards Sapiens valve by femoral access. In the echocardiography follow-up, an aorta–right ventricular (Ao-RV) fistula was noted with restrictive flow and no significant shunt and it was treated conservatively. Three years after TAVI, the patient underwent cardiac surgery because of worsening heart failure due to a severe degenerative mitral regurgitation with tethering of P2 due to left ventricular remodelling, a posterior jet of severe regurgitation, and left ventricular dilatation. Surgical replacement of the TAVI and aortic root with a bioprosthesis (Medtronic Freestyle) and direct closure of the fistula was performed along with the mitral valve replacement. The patient was discharged with a good clinical result and no evidence of remaining Ao-RV fistula at transthoracic echocardiography. DISCUSSION: Aorta–right ventricular fistula is a rare entity. Most reported cases arise after rupture of a congenital coronary sinus aneurism, endocarditis, trauma, and aortic valve or aortic root surgery. This is the 10th reported case after TAVI (9 after an Edwards Sapiens TAVI). Non-significant shunt can be treated conservatively but development of heart failure and death are described in significant shunts. Balloon post-dilatation and the absence of surgical calcium debridement inherent to TAVI may theoretically contribute to the development of the fistula. Surgical replacement and closure of the fistula is a therapeutic option for this entity even in high-risk patients.
format Online
Article
Text
id pubmed-7649498
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher Oxford University Press
record_format MEDLINE/PubMed
spelling pubmed-76494982020-11-16 Complex cardiac surgery in a high-risk patient with new-onset severe mitral regurgitation and aorta to right ventricular fistula after transcatheter aortic valve implantation: a case report Verdugo-Marchese, Mario Monney, Pierre Muller, Olivier Kirsch, Matthias Eur Heart J Case Rep Case Reports BACKGROUND: Transcatheter aortic valve implantation (TAVI) is the procedure of choice for aortic stenosis in high surgical risk patients, but it is no free from complications. CASE SUMMARY: A 86-year-old patient with severe aortic stenosis underwent TAVI 3 years ago with an Edwards Sapiens valve by femoral access. In the echocardiography follow-up, an aorta–right ventricular (Ao-RV) fistula was noted with restrictive flow and no significant shunt and it was treated conservatively. Three years after TAVI, the patient underwent cardiac surgery because of worsening heart failure due to a severe degenerative mitral regurgitation with tethering of P2 due to left ventricular remodelling, a posterior jet of severe regurgitation, and left ventricular dilatation. Surgical replacement of the TAVI and aortic root with a bioprosthesis (Medtronic Freestyle) and direct closure of the fistula was performed along with the mitral valve replacement. The patient was discharged with a good clinical result and no evidence of remaining Ao-RV fistula at transthoracic echocardiography. DISCUSSION: Aorta–right ventricular fistula is a rare entity. Most reported cases arise after rupture of a congenital coronary sinus aneurism, endocarditis, trauma, and aortic valve or aortic root surgery. This is the 10th reported case after TAVI (9 after an Edwards Sapiens TAVI). Non-significant shunt can be treated conservatively but development of heart failure and death are described in significant shunts. Balloon post-dilatation and the absence of surgical calcium debridement inherent to TAVI may theoretically contribute to the development of the fistula. Surgical replacement and closure of the fistula is a therapeutic option for this entity even in high-risk patients. Oxford University Press 2020-10-02 /pmc/articles/PMC7649498/ /pubmed/33204983 http://dx.doi.org/10.1093/ehjcr/ytaa206 Text en © The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Case Reports
Verdugo-Marchese, Mario
Monney, Pierre
Muller, Olivier
Kirsch, Matthias
Complex cardiac surgery in a high-risk patient with new-onset severe mitral regurgitation and aorta to right ventricular fistula after transcatheter aortic valve implantation: a case report
title Complex cardiac surgery in a high-risk patient with new-onset severe mitral regurgitation and aorta to right ventricular fistula after transcatheter aortic valve implantation: a case report
title_full Complex cardiac surgery in a high-risk patient with new-onset severe mitral regurgitation and aorta to right ventricular fistula after transcatheter aortic valve implantation: a case report
title_fullStr Complex cardiac surgery in a high-risk patient with new-onset severe mitral regurgitation and aorta to right ventricular fistula after transcatheter aortic valve implantation: a case report
title_full_unstemmed Complex cardiac surgery in a high-risk patient with new-onset severe mitral regurgitation and aorta to right ventricular fistula after transcatheter aortic valve implantation: a case report
title_short Complex cardiac surgery in a high-risk patient with new-onset severe mitral regurgitation and aorta to right ventricular fistula after transcatheter aortic valve implantation: a case report
title_sort complex cardiac surgery in a high-risk patient with new-onset severe mitral regurgitation and aorta to right ventricular fistula after transcatheter aortic valve implantation: a case report
topic Case Reports
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7649498/
https://www.ncbi.nlm.nih.gov/pubmed/33204983
http://dx.doi.org/10.1093/ehjcr/ytaa206
work_keys_str_mv AT verdugomarchesemario complexcardiacsurgeryinahighriskpatientwithnewonsetseveremitralregurgitationandaortatorightventricularfistulaaftertranscatheteraorticvalveimplantationacasereport
AT monneypierre complexcardiacsurgeryinahighriskpatientwithnewonsetseveremitralregurgitationandaortatorightventricularfistulaaftertranscatheteraorticvalveimplantationacasereport
AT mullerolivier complexcardiacsurgeryinahighriskpatientwithnewonsetseveremitralregurgitationandaortatorightventricularfistulaaftertranscatheteraorticvalveimplantationacasereport
AT kirschmatthias complexcardiacsurgeryinahighriskpatientwithnewonsetseveremitralregurgitationandaortatorightventricularfistulaaftertranscatheteraorticvalveimplantationacasereport