Pathophysiologic, diagnostic, and management considerations.

Catheter Cardiovasc Interv. 2015 Feb 1;86(3):438-52. doi: 10.1002/ccd.25897. Epub 2015 Mar 16.

Iatrogenic aortopulmonary communications after transcatheter interventions on the right ventricular outflow tractor pulmonary artery: Pathophysiologic, diagnostic, and management considerations.

Torres A1Sanders SP2Vincent JA1El-Said HG3Leahy RA4Padera RF5McElhinney DB6.

Comment: In this study, Torres and colleagues seek to investigate the spectrum, etiology, and management of traumatic aortopulmonary communications after transcatheter interventions on the pulmonary circulation. There present 3 new cases and review the literature to present a total of 18 patients with iatrogenic AP communication after transcatheter interventions on the PAs or RVOT, primarily in patients with transposition of the great arteries who underwent PA angioplasty after an arterial switch operation or after transcatheter pulmonary valve replacement in patients who had undergone a Ross procedure. The etiology of AP communications in this group of patients is likely PA trauma and/or distortion of the neo-aortic anastomosis resulting from the intervention, with subsequent dissection through the extravascular connective tissue and devitalized tissue at the site of the surgical anastomosis. Of the 18 cases, only 4 were diagnosed during the same catheterization and 3 more within the next 2 days. The authors emphasize that providers should maintain a high index of suspicion for this rare complications as signs and symptoms of an AP communication may be similar to those of other serious events and the initial response, PA angiography, may not diagnose the problem. Once diagnosed, a number of therapeutic strategies have been utilized, including covered CP stenting of the RVOT or branch PAs, aortic endograft placement, and a variety of closure devices (i.e. Amplatzer septal occluder).