SHM Converge Scientific Abstract ePoster Gallery-Aorto-Right Ventricular Fistula After Transcatheter Aortic Valve Replacement Presenting as Cardiac Arrest: A Case for Hospitalists

Pdf Summary

This case describes what appears to be the first reported aorto-right ventricular fistula (ARVF) after transcatheter aortic valve replacement (TAVR) presenting as cardiac arrest. TAVR is a major treatment for severe aortic stenosis, but rare complications like ARVF may be missed because early symptoms can be subtle.<br /><br />The patient was a 69-year-old man with severe aortic stenosis, heart failure with reduced ejection fraction, and end-stage renal disease who had undergone an uncomplicated TAVR four weeks earlier. During routine hemodialysis, he became dizzy and developed monomorphic ventricular tachycardia, progressing to cardiac arrest requiring defibrillation and intubation.<br /><br />On arrival to the ICU, he had a wide pulse pressure and a continuous murmur throughout systole and diastole, raising concern for paravalvular leak or aortic regurgitation. Transthoracic echocardiography showed continuous flow from the aortic root to the right ventricle, suggesting an aorto-RV fistula. Transesophageal echocardiography confirmed a 6 mm fistula near the prosthetic valve. He was transferred to a tertiary center for planned percutaneous closure with an Amplatzer vascular plug, but his condition rapidly deteriorated and he died before the procedure could be performed.<br /><br />The proposed mechanism was a left-to-right shunt causing reduced systemic vascular resistance and diastolic blood pressure, impaired coronary perfusion, and increased risk of ventricular arrhythmias. Hemodialysis-related hypovolemia likely worsened myocardial ischemia and contributed to arrest.<br /><br />The key message is that ARVF after TAVR, though extremely rare, can cause fatal hemodynamic compromise. Early recognition, prompt echocardiographic assessment, and rapid referral for intervention are critical. Hospitalists caring for post-TAVR patients play an important role in identifying this complication early.

Asset Subtitle

FNU Pratishruti

Meta Tag

Author List Darpan Bansal, FNU Pratishruti, Pushan Aggarwal, Ram Bhutani

Category Clinical Vignettes

Concept Aorto-Right Ventricular Fistula

Concept Transcatheter Aortic Valve Replacement

Concept Echocardiography

Concept Cardiac Arrest

Concept Hemodynamic Instability

Distinguished Non-Finalist

Presenter Organization Johns Hopkins University School of Medicine

Presenting Author FNU Pratishruti

Track Adult

Keywords

transcatheter aortic valve replacement

aorto-right ventricular fistula

cardiac arrest

ventricular tachycardia

aortic stenosis

echocardiography

paravalvular leak

hemodialysis

left-to-right shunt

Amplatzer vascular plug

Aorto-Right Ventricular Fistula

Transcatheter Aortic Valve Replacement

Echocardiography

Cardiac Arrest

Hemodynamic Instability