SHM Converge Scientific Abstract ePoster Gallery-Persistent Decompensated Heart Failure Post-Tavr Should Prompt Investigation for Intracardiac Fistula Development.

Pdf Summary

This case report describes a 75-year-old man who developed recurrent heart failure after transcatheter aortic valve replacement (TAVR) for severe aortic stenosis. Early after TAVR, he was hospitalized with acute decompensated heart failure, but initial transthoracic echocardiography showed normal valve function, and early investigations including right-heart catheterization and transesophageal echocardiography did not identify a shunt.<br /><br />Two years later, he was readmitted with new right-sided heart failure and pre-capillary pulmonary hypertension. Repeat right-heart catheterization again showed an oxygen saturation step-up between the right atrium and right ventricle, suggesting a left-to-right shunt. Repeat transesophageal echocardiography then revealed a previously occult aorto-right ventricular fistula (ARVF), a rare intracardiac complication of TAVR.<br /><br />The report emphasizes that persistent or unexplained decompensated heart failure after TAVR should prompt evaluation for structural complications, especially when common causes have been excluded. Key clues to ARVF include new right ventricular dilation or dysfunction, pre-capillary pulmonary hypertension, and oxygen saturation step-up on catheterization.<br /><br />Because diagnosis can be challenging and delayed recognition may lead to significant hemodynamic consequences and repeated hospitalizations, clinicians should maintain a high index of suspicion. In selected patients, repair may require percutaneous closure or surgical intervention, though this patient was not a procedural candidate and was managed medically.

Asset Subtitle

Andrew J. Biscardi

Meta Tag

Author List Andrew J. Biscardi, Karl Richardson, Manrique Alvarez, Wesley Parker

Category Clinical Vignettes

Concept Acute Decompensated Heart Failure

Concept Aorto-Right Ventricular Fistula

Concept Transcatheter Aortic Valve Replacement

Concept Intracardiac Fistula

Concept Right Heart Catheterization

Distinguished Non-Finalist

Presenter Organization Atrium Health Wake Forest Baptist Medical Center

Presenting Author Andrew J. Biscardi

Track Adult

Keywords

transcatheter aortic valve replacement

TAVR

heart failure

aorto-right ventricular fistula

ARVF

pulmonary hypertension

right-heart catheterization

transesophageal echocardiography

left-to-right shunt

aortic stenosis

Acute Decompensated Heart Failure

Aorto-Right Ventricular Fistula

Transcatheter Aortic Valve Replacement

Intracardiac Fistula

Right Heart Catheterization