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Aorto-right Ventricular Fistula Closure after TAVR Guided by Intracardiac Echocardiography

Intracardiac echocardiography (ICE) has been historically used to guide device closure of interatrial communications and transeptal access for electrophysiological ablations. Recent advances in structural heart interventions led to an increase in ICE utilization as an alternative to transesophageal echocardiography (TEE). Transcatheter aortic valve replacement (TAVR) has emerged as an effective treatment in patients with severe aortic stenosis who are at prohibitive, high and intermediate risk for surgical aortic valve replacement. The development of aorto-right ventricular fistula, a variant of annular rupture, is a rare complication of TAVR and has only been documented in a few case reports. Locating the fistula intraoperatively with TEE can be challenging due to the artifact from the TAVR prosthesis. Herein we report a case of a successful percutaneous aorto-right ventricular fistula closure guided by ICE.