Aorto-right ventricular fistula with a prominent diastolic shunt flow after transcatheter aortic valve replacement: A unique case of a valve-cusp-regulated shunt flow.

Aorto-right ventricular fistula (ARVF) is a rare complication of transcatheter aortic valve replacement (TAVR) with limited evidence to guide its treatment. Five months following TAVR, an 82-year-old woman complained of edema and dyspnea. ARVF was confirmed by echocardiography, which revealed a shunt flow originating at the site of the prosthetic valve to the right ventricle. Unlike continuous shunt flow published in the literature, in this case the flow was observed distinctly during diastole. This situation was attributed to the prosthetic valve opening during systole, interrupting the shunt flow. After refusing invasive treatment, she was treated conservatively. As TAVR becomes more common, we will encounter this rare consequence more often. To determine the best management techniques for this rare condition, more research is required. Learning objective: Aorto-right ventricular fistula (ARVF), a rare complication of transcatheter aortic valve replacement (TAVR), can manifest with varying localizations and hemodynamic characteristics. An ARVF with flow controlled by the aortic cusp is reported here for the first time. Patients post-TAVR should undergo long-term echocardiographic follow-up for ARVF as well.