Key result
Percutaneous LVOT-to-LA fistula closure after aortic bioprosthetic valve fracture is technically feasible in experienced centers.
Why the study?
Left ventricular outflow tract to left atrium fistula is an uncommon but serious complication of TAVR associated with adverse clinical outcomes.
Does percutaneous transvenous closure using an Amplatzer IV vascular plug improve symptoms in a patient with an LVOT-LA fistula post-TAVR valve fracture?
Case Report (n=1)
Does percutaneous transvenous closure using an Amplatzer IV vascular plug improve symptoms in a patient with an LVOT-LA fistula post-TAVR valve fracture?
Answers are grounded in this paper and cite their sources.
Percutaneous closure of an iatrogenic LVOT-LA fistula using a low-profile occlusion device like the Amplatzer IV vascular plug is a feasible and effective treatment strategy.
BACKGROUND: Left ventricular outflow tract to left atrium (LVOT-LA) fistula is an uncommon but serious complication of transcatheter aortic valve replacement (TAVR), associated with adverse clinical outcomes. CASE SUMMARY: A 78-year-old man with a history of surgical aortic valve replacement, followed by valve-in-valve TAVR, presented with significant dyspnea thought to be due to a valve-in-valve patient prosthesis mismatch. He underwent valve fracture of the TAVR valve. Post-balloon valvuloplasty, the patient developed an LVOT-LA fistula. He presented with worsening exertional dyspnea. Transesophageal echocardiography confirmed the fistula, and a percutaneous transvenous closure using an Amplatzer IV vascular plug was successfully performed. After the procedure, the patient's symptoms markedly improved. DISCUSSION: Percutaneous closure of an LVOT-LA fistula is technically feasible when performed in experienced centers. Small, low-profile occlusion devices, such as the Amplatzer IV vascular plug, are preferred to minimize the risk of interference with adjacent valvar structures. TAKE-HOME MESSAGES: Intracardiac shunts are uncommon but serious complications of TAVR. Percutaneous closure is technically feasible when performed at experienced centers.
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Sedhom et al. (2026) conducted a case report in Left ventricular outflow tract to left atrium (LVOT-LA) fistula (n=1). Percutaneous transvenous closure using an Amplatzer IV vascular plug was evaluated on Successful closure and symptom improvement. Percutaneous transvenous closure of an LVOT-LA fistula using an Amplatzer IV vascular plug was successfully performed in a 78-year-old man, resulting in marked symptom improvement.
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