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Updated: Sep 10, 2025
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Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
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Iatrogenic VSDs After TAVRs and Electrophysiologic Implications
Mohammad Saad Husain1, Marco Radaelli1, Marc El-Khoury1
1MedStar Washington Hospital Center/Georgetown, Internal Medicine Teaching Service, Washington, DC, USA.
JACC. Case Reports
|August 22, 2025
Summary
Iatrogenic ventricular septal defects (VSDs) after transcatheter aortic valve replacement (TAVR) are rare. Left bundle branch pacing (LBBP) is a feasible strategy for managing these complex cases with conduction abnormalities.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Iatrogenic ventricular septal defects (VSDs) are infrequent but significant complications following transcatheter aortic valve replacement (TAVR).
- Conduction abnormalities post-TAVR can be complicated by the presence of a VSD, impacting pacing strategies.
Observation:
- Two cases of perimembranous VSDs post-TAVR with associated conduction disease are presented.
- One patient developed a Gerbode-type defect and pulmonary hypertension after a redo valve procedure, managed palliatively.
- The second patient had a restrictive VSD diagnosed on follow-up, responding to medical therapy.
Findings:
- Successful left bundle branch pacing (LBBP) was achieved in both patients despite septal disruption, utilizing septal drilling and precise lead placement.
- These cases highlight the technical feasibility of LBBP in the context of post-TAVR VSDs.
Implications:
- Post-TAVR VSDs require a high index of clinical suspicion due to their uncommon nature and limited characterization.
- Left bundle branch pacing (LBBP) offers a viable pacing solution for patients with altered septal anatomy due to VSDs post-TAVR, necessitating individualized procedural planning.
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