Author + information
- Received November 28, 2014
- Revision received December 30, 2014
- Accepted January 15, 2015
- Published online June 1, 2015.
- Sharayne D. Mark, MD,
- Vikram Prasanna, MD,
- Victor A. Ferrari, MD and
- Howard C. Herrmann, MD∗ ()
- Cardiology Division, Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
- ↵∗Reprint requests and correspondence:
Dr. Howard C. Herrmann, Hospital of the University of Pennsylvania, 9038 West Gates Pavilion, 3400 Spruce Street, Philadelphia, Pennsylvania 19104.
An 89-year old man with severe, symptomatic aortic stenosis (Society of Thoracic Surgeons estimated mortality of 5.6%) underwent transcatheter aortic valve replacement (TAVR) with a #29 Sapien 3 (Edwards Lifesciences, Inc., Irvine, California) prosthesis as part of the PARTNER trial (Placement of Aortic Transcatheter Valve Trial) intermediate-risk registry cohort. Post-operatively, a new asymptomatic restrictive membranous ventricular septal defect (VSD) was noted on transthoracic echocardiogram, a rare complication post–transcatheter aortic valve replacement (1,2). One month later, he presented with a progressive nonproductive cough and dyspnea. A transesophageal echocardiogram revealed a larger VSD and new left ventricular dysfunction (Figure 1A, Online Video 1; Figure 1C, Online Video 3). Right heart catheterization demonstrated a Qp/Qs ratio of 1.6:1. The decision was made to repair the VSD with a transcatheter closure device. Under general anesthesia and transesophageal echocardiographic guidance, percutaneous VSD closure was performed with an Amplatzer Muscular VSD occluder (St. Jude Medical, Inc., St. Paul, Minnesota) (10-mm diameter) with an anterograde arteriovenous loop technique. No significant shunting was observed post-deployment (Figures 1B, 1D, 1E, and 1F, Online Videos 2, 3, 5, and 6).
For supplemental videos and their legends, please see the online version of this article.
Dr. Ferrari has fiducial responsibilities to the Society for Cardiovascular Magnetic Resonance Executive Committee and the American College of Cardiology Board of Governors. Dr. Herrmann has received research funding from Abbott Vascular, Edwards Lifesciences, St. Jude Medical, Medtronic, Gore, Siemens, Boston Scientific, and MitraSpan; has received consultant fees and honoraria from Siemens, Edwards Lifesciences, Merck, and GlaxoSmithKline; and has equity in Microinterventional Devices. Drs. Mark and Prasanna have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 28, 2014.
- Revision received December 30, 2014.
- Accepted January 15, 2015.
- American College of Cardiology Foundation
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