Transventricular and Transseptal Closure of Left Ventricular Outflow Tract Pseudoaneurysms After Mechanical Aortic Valve Replacement: Access‐Related and Technical Considerations

BACKGROUND: Pseudoaneurysms of the left ventricular outflow tract (LVOT) are a life-threatening entity, typically developing as a complication of infective endocarditis or prior cardiac surgery. They should be repaired to reduce the risk of systemic embolization and the catastrophic risks of rupture. Surgical resection has been the gold standard; however, percutaneous transcatheter closure has emerged as an alternative for patients deemed to be at prohibitive surgical risk. The procedural access routes and technical methods for closure remain variable and patient specific. AIMS: This study aims to describe unique cases of percutaneous LVOT pseudoaneurysm closure in patients with mechanical valves. METHODS: From 2023 to 2026, 4 patients underwent percutaneous transcatheter closure of LVOT pseudoaneurysms at our center after prior mechanical aortic valve or root replacement (AVR). RESULTS: Case 1 highlights an antegrade transseptal approach to pack a wide-necked post-endocarditis pseudoaneurysm with coils. Case 2 demonstrates the ability of a microcatheter to engage a slit-like orifice and utilization of coil embolization without device closure of the orifice due to proximity to the aortic valve ring. Case 3 illustrates a combined approach using devices to close 2 separate orifices and coils to pack a large aneurysm sac. Case 4 represents the first reported case of an excluded LVOT pseudoaneurysm accessed via a percutaneous, transthoracic puncture of the RV free wall and subsequent traversal of the interventricular septum. CONCLUSIONS: In our experience, percutaneous transcatheter closure is a feasible option in most cases and should be considered prior to operative revision unless there is an unstable valve, active endocarditis, or other complicating circumstance that mandate prosthetic valve removal or a surgical approach for other reasons.