Mechanisms and Management of Acquired Aseptic Intracardiac Communications After Transcatheter Aortic Valve Implantation: Single-Center Case Series Insights.

BACKGROUND: Acquired aseptic intracardiac communications (AICCs) are rare but clinically relevant structural complications following transcatheter aortic valve implantation (TAVI), typically resulting from mechanical injury to the aortic annulus, interventricular septum, or adjacent structures. Evidence regarding their incidence, mechanisms, and optimal management remains limited. AIM: To review the mechanisms and management of post-TAVI AICCs and to present a single-center experience focusing on multimodality imaging, procedural characteristics, and outcomes of transcatheter closure. METHODS: We retrospectively analyzed consecutive patients diagnosed with AICCs after TAVI at our institution. Clinical characteristics, anatomical mechanisms, imaging findings, procedural details, and follow-up outcomes were evaluated. A complementary literature review was performed. RESULTS: Four patients (mean age 74 years) developed iatrogenic intracardiac communications, including ventricular septal defects, aorto-right ventricular fistulas, and complex root injuries. Mechanisms included severe annular or subannular calcification, aggressive balloon dilation, and valve-in-valve procedures with frame fracture. Multimodality imaging using transthoracic and transesophageal echocardiography combined with cardiac computed tomography enabled precise anatomical characterization and procedural planning in all cases. Following Heart Team discussion, transcatheter closure achieved procedural success in all patients, with complete or functionally complete elimination of shunt flow and no major device-related complications. During follow-up ranging from 8 months to 2.5 years, all patients remained clinically stable without recurrence. CONCLUSIONS: AICCs after TAVI are mechanism-driven complications requiring early recognition and individualized management. Multimodality imaging is central to diagnosis and procedural planning, and transcatheter closure represents a safe and effective first-line treatment in appropriately selected patients.