Aorto-atrial fistula formation and therapy

Jainandunsing, Jayant S.; Linnemann, R.; Natour, Nicole; Lorusso, Roberto; Gelsomino, Sandro; Johnson, Dan

doi:10.21037/jtd.2019.02.63

Cited by 15 publications

(20 citation statements)

References 28 publications

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“…It may cause overt right heart failure and cardiac arrhythmias such as atrial fibrillation. 14 The percutaneous approach consists of deploying a small occluder device (Amplatzer Vascular Plug, AVP) to close the fistula. This modality was reported in a case by Vainrib et al .…”

Section: Discussionmentioning

confidence: 99%

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Case report: iatrogenic left ventricular outflow tract to right atrium fistula after trans-femoral transcatheter aortic valve implantation associated with asymmetric septal hypertrophy

Ayouby

Gilard

Hébert

et al. 2021

European Heart Journal - Case Reports

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Background The transcatheter aortic valve implantation (TAVI) is becoming a leading treatment option for symptomatic aortic stenosis for patients in all surgical risk categories. Recognition and management of potential complications are essential to ensure patient life and comfort. We present here a case report of a left ventricular outflow tract (LVOT) to right atrium (RA) fistula which is an extremely rare complication after TAVI. Case summary An 85-year-old man with symptomatic severe aortic stenosis and non-obstructive asymmetric septal hypertrophy (ASH) underwent a transfemoral TAVI. Soon after the procedure, he developed chest pain and atrial fibrillation with rapid ventricular response. A transthoracic echocardiography followed by a transoesophageal echocardiography showed a small pseudo-aneurysm with a fistulous tract between the LVOT and the RA. This was confirmed by a contrast computed tomography scan of the heart. The patient remained asymptomatic throughout the rest of hospitalization. He was treated with diuretics and discharged home. One month follow-up showed increase in the width, jet size, and gradient of the fistula but the patient remained asymptomatic. The decision by Heart team was to closely monitor him for symptoms since the fistula is difficult to access percutaneously. Discussion We report a unique case of an LVOT to RA fistula in the setting of ASH that occurred post-TAVI. Alcohol septal ablation was proposed pre-TAVI for patients having septal thickening >15 mm and dynamic obstruction. Treatment options for iatrogenic fistula vary from symptomatic treatment to percutaneous or surgical closure.

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Section: Discussionmentioning

confidence: 99%

“…The patient was completely asymptomatic. Due to lack of strong evidence, 14 and the atypical fistula location, the Heart team decision was to closely monitor the patient for symptoms onset and to reassess fistula closure using a percutaneous approach.…”

Section: Discussionmentioning

confidence: 99%

Case report: iatrogenic left ventricular outflow tract to right atrium fistula after trans-femoral transcatheter aortic valve implantation associated with asymmetric septal hypertrophy

Ayouby

Gilard

Hébert

et al. 2021

European Heart Journal - Case Reports

View full text Add to dashboard Cite

show abstract

“…Aorto-atrial fistulae are most commonly caused by endocarditis, a paravalvular abscess, sinus of Valsalva aneurysm rupture, or aortic dissection and, less commonly, as a complication of cardiac surgery. 2 Reports that have described AAF as a noninfectious complication of cardiac surgery mostly described cases occurring after aortic surgery. 2 Upon review of the literature, we encountered only 1 prior case of an AAF as a result of tricuspid valve repair.…”

Section: To the Editormentioning

confidence: 99%

“…2 Reports that have described AAF as a noninfectious complication of cardiac surgery mostly described cases occurring after aortic surgery. 2 Upon review of the literature, we encountered only 1 prior case of an AAF as a result of tricuspid valve repair. Menon et al 3 described an aorto-right atrial fistula in a 73year-old patient who previously had undergone mitral and tricuspid valve repair.…”

Section: To the Editormentioning

confidence: 99%

“…The clinical presentation of AAF encompasses a wide range of signs and symptoms of heart failure including dyspnea, chest pain, palpitations, fatigue, weakness, coughing, or edema. 2,4 Physical examination may reveal a continuous murmur at the right upper sternal border. 2 Echocardiography plays an essential role in making the diagnosis of AAF.…”

Section: To the Editormentioning

confidence: 99%

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