# Transcatheter Closure of an LVOT to LA Fistula After Aortic Bioprosthetic Valve Fracture

## TL;DR

A patient developed a rare heart defect after a valve replacement procedure, which was successfully treated with a minimally invasive closure technique.

## Contribution

Demonstrates the technical feasibility of percutaneous closure for LVOT-LA fistulas using small occlusion devices like the Amplatzer IV vascular plug.

## Key findings

- Percutaneous closure of LVOT-LA fistulas is feasible in experienced centers.
- The Amplatzer IV vascular plug is effective for such closures.
- Symptoms improved significantly after the procedure.

## Abstract

Left ventricular outflow tract to left atrium (LVOT-LA) fistula is an uncommon but serious complication of transcatheter aortic valve replacement (TAVR), associated with adverse clinical outcomes.

A 78-year-old man with a history of surgical aortic valve replacement, followed by valve-in-valve TAVR, presented with significant dyspnea thought to be due to a valve-in-valve patient prosthesis mismatch. He underwent valve fracture of the TAVR valve. Post–balloon valvuloplasty, the patient developed an LVOT-LA fistula. He presented with worsening exertional dyspnea. Transesophageal echocardiography confirmed the fistula, and a percutaneous transvenous closure using an Amplatzer IV vascular plug was successfully performed. After the procedure, the patient's symptoms markedly improved.

Percutaneous closure of an LVOT-LA fistula is technically feasible when performed in experienced centers. Small, low-profile occlusion devices, such as the Amplatzer IV vascular plug, are preferred to minimize the risk of interference with adjacent valvar structures.

Intracardiac shunts are uncommon but serious complications of TAVR. Percutaneous closure is technically feasible when performed at experienced centers.