Iatrogenic Reopening of a Congenital VSD After TAVR

Transcatheter aortic valve replacement (TAVR) has become an increasingly used technique for patients with severe aortic stenosis who are at high risk of perioperative mortality during surgical valve replacement.

Here we describe the first case to our knowledge of a patient with a congenital perimembranous ventricular septal defect with prior spontaneous closure who experienced a post-TAVR acquired intracardiac shunt (AICS) due to the reopening of her ventricular septal defect, which caused new-onset heart failure and required surgical closure.

AICS is a known complication of TAVR, but its risk in patients with congenital heart disease, particularly of the intraventricular septum, is poorly understood.

In patients with congenital heart disease, detailed structural imaging should be obtained to better understand the anatomy before TAVR. Additionally, any patient with new-onset heart failure post-TAVR should be promptly evaluated for AICS.