CTICasesRight Ventricular Outflow Tract Fistula and RCA Epicardial Hemorrhage post-TAVR
Imaging findings
CT angiography demonstrates a communication between the aortic valve plane and the right ventricular outflow tract, representing an iatrogenic fistula formed during transcatheter aortic valve replacement. In addition, there is severe epicardial hemorrhage tracking along and exquisitely surrounding the entire course of the right coronary artery between the visceral pericardium and myocardial cells.
Key takeaways
An iatrogenic fistula to the right ventricular outflow tract and extensive epicardial hemorrhage are rare complications of balloon inflation during transcatheter aortic valve replacement. Even with significant epicardial blood tracking along the right coronary artery, patients can remain hemodynamically stable and may be managed conservatively for small fistulas without surgical closure.
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