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Transcatheter Repair of Aortopulmonary Fistula With VSD Occluder After Surgical Aortic Valve Replacement for Aortic
Hardik A Valand1, Triston Smith2, David Lasorda3
1Allegheny General Hospital, Department of Internal Medicine, Pittsburgh, Pennsylvania, USA; Allegheny General Hospital, Department of Interventional Cardiology, Pittsburgh, Pennsylvania, USA.
Background:
Infective endocarditis can lead to the rare and potentially fatal aortopulmonary fistula.
Case Summary:
We report a 52-year-old man with methicillin-sensitive Staphylococcus aureus bacteremia and aortic valve endocarditis complicated by a left middle cerebral artery stroke. After emergent aortic sinus debridement and valve replacement, imaging revealed an aortopulmonary fistula. Left-to-right shunting was confirmed. As traditional surgical repair was unsuitable, a ventricular septal defect occluder was deployed via a transcatheter approach. Follow-ups confirmed a well-seated device, mild pulmonic regurgitation, and no symptoms.
Discussion:
Effectively managing aortopulmonary fistulas in patients with infective endocarditis is a multidisciplinary process combining advanced imaging techniques, hemodynamic assessment, and an innovative percutaneous approach.
Take-Home Message:
This case demonstrates that a minimally invasive transcatheter approach is viable for managing aortopulmonary fistula in high-risk patients after valve replacement.
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