Applications of three-dimensional printing in percutaneous closure of aortic-to-right ventricle fistula after transcatheter aortic valve replacement: a case report

TL;DR

3D printing helped guide a minimally invasive procedure to close a heart defect after a valve replacement in a high-risk patient.

Contribution

Demonstrates the use of 3D printing for pre-procedural planning in percutaneous closure of a rare TAVR-related complication.

Findings

3D printing enhanced understanding of complex anatomy for ARV fistula closure planning.

Successful percutaneous closure was achieved using an Amplatzer atrial septal occluder.

The case highlights the potential of 3D printing in enabling patient-specific treatment strategies.

Abstract

Percutaneous closure of aortic-to-right ventricle (ARV) fistula has emerged as an alternative to surgical management in selected cases. The use of three-dimensional (3D) printing in interventional planning for structural heart disease provides a concrete understanding, and it is useful in diagnostic assessment and to guide treatment approaches and to simulate procedures.

We report a case of a 70-year-old male presenting in cardiogenic shock due to severe aortic stenosis and reduced left ventricular ejection fraction. The patient had several comorbidities and was deemed not eligible for cardiac surgery. After transcatheter aortic valve replacement (TAVR), an ARV fistula was discovered on the TTE. Due to complex anatomical considerations, a 3D printed model of the patient’s anatomy was employed to supplement the decision-making process and technical planning of percutaneous ARV closure. Successful closure of the fistula with the use of the Amplatzer atrial septal occluder was subsequently performed.

Three-dimensional printing improves the understanding of complex structures of cardiac diseases, allowing for enhanced planning and simulation of the procedure. This case, demonstrating the effective percutaneous closure of a TAVR-related ARV fistula facilitated by the use of 3D printed anatomical models in the pre-procedural phase, highlights the technology’s potential in advancing patient-specific treatment approaches.

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