Percutaneous Closure of Left Ventricular Outflow Tract to Left Atrium Fistula With 3-Dimensional Printing Simulation

Leo Kar Lok Lai; Georgi Fram; Hussayn Alrayes; Dimitrios Apostolou; James Alter; Bryan Zweig; John Dawdy; Sachin Parikh; Brian P O'Neill; Pedro A Villablanca; Pedro Engel Gonzalez; William W O'Neill; James C Lee; Tiberio M Frisoli

doi:10.1016/j.jaccas.2025.104889

Percutaneous Closure of Left Ventricular Outflow Tract to Left Atrium Fistula With 3-Dimensional Printing Simulation

JACC Case Rep. 2025 Sep 3;30(26):104889. doi: 10.1016/j.jaccas.2025.104889.

Affiliations

¹ Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA. Electronic address: l.k.l.lai816@outlook.com.
² Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA.
³ Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA. Electronic address: tfrisol1@hfhs.org.

Abstract

Case summary: We present a case of a 31-year-old man with a history of aortic valve endocarditis and surgical aortic intervention. Computed tomography revealed a complex serpiginous fistula with 2 openings between the left ventricular outflow tract and the left atrium. Using 3-dimensional printing simulation for device fit testing and planning, the "mother-in-daughter" system, multimodality guidance with computed tomography angiography C-arm prediction, and 3-dimensional transesophageal echocardiogram guidance successfully guided an 18-mm Cribriform Amplatzer device deployed via a retrograde approach.

Take-home message: Three-dimensional printing simulation significantly enhances preprocedural planning and device selection for this complex fistula closure, facilitating successful percutaneous repairs in high-risk patients.

Keywords: 3D printing; CTA; LA; LVOT; TEE; fistula.