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Case Reports
. 2025 Aug 20;30(24):104671.
doi: 10.1016/j.jaccas.2025.104671.

Iatrogenic VSDs After TAVRs and Electrophysiologic Implications

Mohammad Saad Husain  1 , Marco Radaelli  1 , Marc El-Khoury  1 , Binaya Basyal  2 , Benjamin B Kenigsberg  3 , Alexander Papolos  3 , Cyrus Hadadi  4
Affiliations
Case Reports

Iatrogenic VSDs After TAVRs and Electrophysiologic Implications

Mohammad Saad Husain et al. JACC Case Rep. .

Abstract

Background: Iatrogenic ventricular septal defects (VSDs) are rare but important complications of transcatheter aortic valve replacement (TAVR). In patients who develop conduction abnormalities post-TAVR, the presence of a VSD can complicate pacing strategies.

Case summary: We report 2 cases of perimembranous VSDs after TAVR, both complicated by conduction disease and managed with left bundle branch pacing (LBBP). The first patient underwent a redo valve procedure that was complicated by a Gerbode-type defect and pulmonary hypertension, culminating in a palliative approach. The second patient developed a restrictive VSD diagnosed on follow-up, with symptom improvement on medical therapy. In both cases, successful LBBP was achieved using septal drilling and precise lead placement despite septal disruption.

Discussion: Post-TAVR VSDs are uncommon and poorly characterized. These cases underscore the feasibility of LBBP in this complex setting and the need for individualized procedural planning.

Take-home messages: Post-TAVR VSDs warrant high clinical suspicion. LBBP is a viable pacing strategy when tailored to altered septal anatomy.

Keywords: aortic valve; bradycardia; cardiac pacemaker; complication; echocardiography; valve replacement; ventricular septal defect.

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Conflict of interest statement

Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
ECGs Before and After TAVR in Patient 1 Electrocardiograms for patient 1 (A) pre-TAVR and (B) post-TAVR. TAVR = transcatheter aortic valve replacement.
Figure 2
Figure 2
Perimembranous VSD Seen on Transesophageal Echocardiogram for Patient 1 End-systolic midesophageal short-axis view with color Doppler demonstrating flow from the left ventricle to the right atrium and right ventricle. VSD = ventricular septal defect.
Figure 3
Figure 3
ECG Progression in Patient 2 Electrocardiograms for patient 2 (A) pre-TAVR, (B) post-TAVR, and (C) at the 9-month follow-up. TAVR = transcatheter aortic valve replacement.
Figure 3
Figure 3
ECG Progression in Patient 2 Electrocardiograms for patient 2 (A) pre-TAVR, (B) post-TAVR, and (C) at the 9-month follow-up. TAVR = transcatheter aortic valve replacement.
Figure 4
Figure 4
Echocardiographic Views of VSD and Pacing Lead in Patient 2 Transesophageal echocardiogram for patient 2 showing VSD on midesophageal short-axis view (top) and the left bundle pacing lead anatomically distant from the VSD near the LVOT seen on a deep gastric view (bottom). LVOT = left ventricular outflow tract; VSD = ventricular septal defect.
See this image and copyright information in PMC

References

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