A Left-to-Right Shunt After Transfemoral TAVR Using Edwards SAPIEN 3

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Transcatheter aortic valve replacement (TAVR) is a primary treatment for severe aortic stenosis (AS).
• While generally safe, TAVR carries risks including cardiac perforation and shunt formation.
• Left-to-right shunts are a rare but significant complication post-TAVR.

Observation:

• An 87-year-old male patient underwent TAVR for AS using an Edwards SAPIEN S3 prosthesis.
• Echocardiography revealed a small channel, indicative of a left-to-right shunt, originating from the right coronary cusp shortly after the procedure.
• This represents the sixth reported case of such a complication.

Findings:

• The identified complication was a left-to-right shunt post-TAVR.
• The shunt was detected via echocardiography originating from the right coronary cusp.
• The patient's condition was successfully managed through medical intervention.

Implications:

• This case highlights the importance of vigilant echocardiographic monitoring after TAVR to detect rare complications like shunts.
• Medical management can be a viable option for specific cases of post-TAVR left-to-right shunts.
• Understanding and reporting these rare complications aids in refining TAVR procedural safety and patient care strategies.