Percutaneous Transcatheter Occlusion of Acquired Gerbode Defect After TAVR

Background: Acquired Gerbode defect is a rare complication of transcatheter aortic valve replacement (TAVR). Percutaneous transcatheter closure is a reasonable yet challenging approach to management. Case Summary: A 74-year-old man presented with decompensated heart failure after TAVR with a balloon-expanding bioprosthesis (Edwards Sapien). Right heart catheterization revealed left-to-right shunting. Transesophageal echocardiography identified a fistula tract from the left ventricular outflow tract to the right atrium (Gerbode defect). This was closed percutaneously with an Amplatzer atrial septal occluder device (Abbott). Device retrieval and replacement was later required given residual paradevice leak. Discussion: Acquired Gerbode defect is a rare complication of TAVR. There are currently no well-defined predictors, but certain patterns of calcification can be a potential cause. The defect can be successfully closed percutaneously using an atrial septal occluder device. Take-Home Messages: Operators should be aware of the risk of an acquired Gerbode defect after TAVR. Transesophageal echocardiography is required for accurate diagnosis, and the defect can be repaired with a percutaneous transcatheter approach.