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Hirata K, Fukuyama A, Tengan T, Takara H. Aorto-right pulmonary venous fistula after mitral valve replacement for prosthetic mitral valve infective endocarditis: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2019; 3:5552972. [PMID: 31436807 PMCID: PMC6764537 DOI: 10.1093/ehjcr/ytz140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/05/2019] [Accepted: 08/04/2019] [Indexed: 12/02/2022]
Abstract
Background Aorto-cavitary fistula is a rare condition, and the most common underlying aetiology is infective endocarditis (IE) of the native or the prosthetic aortic valve. We report a case of aorto-right inferior pulmonary venous fistula following redo mitral valve replacement (MVR) for prosthetic mitral valve IE. Case summary A 74-year-old woman underwent urgent redo MVR for prosthetic mitral valve IE. The post-operative course was complicated with heart failure and mediastinal haematoma compressing the left atrium. The haematoma was surgically removed and laceration of the left atrial wall was suture ligated; this was attributed to the surgical trauma dissection of the adhesive tissues. One-week post-operatively, a continuous murmur emerged, which prompted an evaluation of the left to right shunt. Transthoracic echocardiography revealed an echolucent area posterior to the aorta, with continuous flow on colour Doppler. Three-dimensional computed tomography showed a fistula between the aorta and the right inferior pulmonary vein. There was a high risk involved in surgical management; therefore, she was managed medically. Fortunately, the continuous murmur and echolucent space disappeared after 6 months. The fistula was considered to be obstructed by spontaneous thrombus formation in the narrowed segment of the fistula tract. Discussion The cause of fistula was attributed to possible surgical trauma in the presence of infection. The present case was unique, as it showed spontaneous healing of an aorto-cavitary fistula, which is very rare. The patient was alive with good health status, 6 years after the MVR.
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Affiliation(s)
- Kazuhito Hirata
- Division of Cardiology, Okinawa Chubu Hospital, 281 Miyazato, Uruma, Okinawa, Japan
| | - Asako Fukuyama
- Division of Cardiology, Okinawa Chubu Hospital, 281 Miyazato, Uruma, Okinawa, Japan
| | - Toshiho Tengan
- Cardiovascular Surgery and Okinawa Chubu Hospital, 281 Miyazato, Uruma, Okinawa, Japan
| | - Hiroaki Takara
- Radiology Okinawa Chubu Hospital, 281 Miyazato, Uruma, Okinawa, Japan
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Ibrahim I, Chua MT, Tan DW, Yap SH, Shen L, Ooi SBS. Impact of 24-hour specialist coverage and an on-site CT scanner on the timely diagnosis of acute aortic dissection. Singapore Med J 2019; 61:86-91. [PMID: 31044257 DOI: 10.11622/smedj.2019039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Acute aortic dissection (AAD) is a rare and potentially fatal condition that has been known to be missed in diagnoses. Our primary objective was to determine if the availability of 24-hour emergency department (ED) specialist coverage and an on-site computed tomography (CT) scanner reduced the rate of missed diagnoses of AAD. METHODS We selected records of patients diagnosed with dissection of the aorta from a hospital's discharge database and death register in the period of January 1998 to December 2014. AAD was defined as missed if imaging to diagnose AAD or a cardiology/cardiothoracic surgical consultation was not obtained in the ED. We compared the rates of missed diagnosis before and after the availability of 24-hour ED specialist coverage and an on-site CT scanner in the ED. RESULTS Among 145 patients, 42 (29.0%) had a missed diagnosis. The proportion of missed AAD was lower in the post-implementation period compared to the pre-implementation period (20.0% vs. 37.3%, odds ratio [OR] 0.42, 95% confidence interval [CI] 0.20‒0.89; p = 0.023). After adjusting for confounders, the difference remained significant (OR 0.31, 95% CI 0.14‒0.70; p = 0.005). In the post-implementation period, concurrent signs of congestive cardiac failure (OR 33.51, 95% CI 1.42‒789.20; p = 0.024) and absence of a widened mediastinum on chest radiography (OR 11.52, 95% CI 1.37‒96.80; p = 0.029) were independent predictors of missed diagnoses. CONCLUSION The availability of 24-hour ED specialist coverage and an on-site CT scanner improved the diagnosis of AAD in our study.
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Affiliation(s)
- Irwani Ibrahim
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mui Teng Chua
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Desmond Wei Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Si Hui Yap
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Liang Shen
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Shirley Beng Suat Ooi
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Jainandunsing JS, Linnemann R, Maessen J, Natour NE, Lorusso R, Gelsomino S, Johnson DM, Natour E. Aorto-atrial fistula formation and therapy. J Thorac Dis 2019; 11:1016-1021. [PMID: 31019791 PMCID: PMC6462686 DOI: 10.21037/jtd.2019.02.63] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Aorta-atrial fistulas (AAF) are a rare but complex pathological condition. These fistulas are characterised by aberrant blood flow between the aorta and either atrium. In the present manuscript, we present a comprehensive overview of the clinical characteristics, formation and treatment of this condition. A literature review was conducted using PubMed. Aorta-Atrial Fistula was used as the primary search term. The clinical presentation of AAF encompasses a wide range of signs and symptoms of heart failure including dyspnoea, chest pain, palpitations, fatigue, weakness coughing or oedema. Causes of fistulas can be congenital or acquired, whilst diagnosis is normally achieved via echocardiography or MRI. Due to the low incidence of AAF, no clinical trials have been performed in AAF patients and treatment strategies are based on expert opinion and consensus amongst the treating physicians. Uncorrected AAF may continue to impose a risk of progression to overt heart failure. The repair of an AAF can either be surgical or percutaneous. AAF is a relatively rare but very serious condition. Clinicians should consider the possibility of AAF, when a new continuous cardiac murmur occurs, especially in patients with a history of cardiac surgery or with signs of heart failure. Closure of the AAF fistula tract is generally recommended. Further studies are required to define optimal therapeutic strategies, but these are hindered by the rarity of the occurrence of this disorder.
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Affiliation(s)
- Jayant S Jainandunsing
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Ralph Linnemann
- Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Jos Maessen
- Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht - CARIM, University of Maastricht, Maastricht, the Netherlands
| | - Nicole E Natour
- Department of Radiology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Roberto Lorusso
- Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht - CARIM, University of Maastricht, Maastricht, the Netherlands
| | - Sandro Gelsomino
- Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht - CARIM, University of Maastricht, Maastricht, the Netherlands
| | - Daniel M Johnson
- Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht - CARIM, University of Maastricht, Maastricht, the Netherlands
| | - Ehsan Natour
- Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht - CARIM, University of Maastricht, Maastricht, the Netherlands
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4
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Aorto-left atrial fistula diagnosed with computed tomographic angiography: A case report. Clin Imaging 2018; 50:235-238. [DOI: 10.1016/j.clinimag.2018.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 03/23/2018] [Accepted: 04/11/2018] [Indexed: 11/20/2022]
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Howard CE, Velasco CE, Roullard CP, Rafael A. Aorto-Right Atrial Fistula After Bentall Repair. Proc (Bayl Univ Med Cent) 2017; 30:301-302. [DOI: 10.1080/08998280.2017.11929622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Alkhouli M, Almustafa A, Kawsara A, Tarabishy A. Transcatheter closure of an aortoatrial fistula following a surgical aortic valve replacement. J Card Surg 2017; 32:186-189. [PMID: 28247471 DOI: 10.1111/jocs.13113] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Mohamad Alkhouli
- West Virginia University Heart and Vascular Institute; Morgantown; West Virginia
| | - Ahmed Almustafa
- West Virginia University Heart and Vascular Institute; Morgantown; West Virginia
| | - Akram Kawsara
- West Virginia University Heart and Vascular Institute; Morgantown; West Virginia
| | - Abdul Tarabishy
- West Virginia University Heart and Vascular Institute; Morgantown; West Virginia
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Said SAM, Mariani MA. Acquired aortocameral fistula occurring late after infective endocarditis: An emblematic case and review of 38 reported cases. World J Cardiol 2016; 8:488-495. [PMID: 27621777 PMCID: PMC4997530 DOI: 10.4330/wjc.v8.i8.488] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 04/23/2016] [Accepted: 06/29/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To delineate the features and current therapeutic option of congenital and acquired aortocameral fistulas (ACF) secondary to iatrogenic or infectious disorders.
METHODS From a PubMed search using the term "aortocameral fistula", 30 suitable papers for the current review were retrieved. Reviews, case series and case reports published in English were considered. Abstracts and reports from scientific meetings were not included. A total of 38 reviewed subjects were collected and analyzed. In addition, another case - an adult male who presented with ACF between commissures of the right and non-coronary sinuses and right atrium as a late complication of Staphylococcus aureus infective endocarditis of the AV - is added, the world literature is briefly reviewed.
RESULTS A total of thirty-eight subjects producing 39 fistulas were reviewed, analyzed and stratified into either congenital (47%) or acquired (53%) according to their etiology. Of all subjects, 11% were asymptomatic and 89% were symptomatic with dyspnea (21 ×) as the most common presentation. Diagnosis was established by a multidiagnostic approach in 23 (60%), single method in 14 (37%) (echocardiography in 12 and catheterization in 2), and at autopsy in 2 (3%) of the subjects. Treatment options included percutaneous transcatheter closure in 12 (30%) with the deployment of the Amplatzer duct or septal occluder and Gianturco coil and surgical correction in 24 (63%).
CONCLUSION Acquired ACF is an infrequent entity which may occur late after an episode of endocarditis of the native AV. The management of ACF is generally by surgical correction but non-surgical device intervention has recently been introduced as a safe alternative.
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Nandate K, Krishnamoorthy V, McIntyre LK, Verrier ED, Mackensen GB. Gunshot-Induced Aorto-Left Atrial Fistula Diagnosed by Intraoperative Transesophageal Echocardiography. Ann Thorac Surg 2016; 101:771-3. [PMID: 26777940 DOI: 10.1016/j.athoracsur.2015.02.129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 12/03/2014] [Accepted: 02/06/2015] [Indexed: 11/17/2022]
Abstract
Aorto-left atrial fistula (AAF) is rarely encountered in clinical practice, and the early diagnosis can be very challenging. This report describes a unique case of AAF caused by a gunshot injury and the pivotal role of transesophageal echocardiography for diagnosis and assessment.
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Affiliation(s)
- Koichiro Nandate
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington.
| | - Vijay Krishnamoorthy
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Lisa K McIntyre
- Division of Trauma Surgery, Department of Surgery, University of Washington, Seattle, Washington
| | - Edward D Verrier
- Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, Washington
| | - G Burkhard Mackensen
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
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10
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Galeas JN, Perez IE, Villablanca PA, Chahal H, Jackson R, Taub CC. Aortocavitary fistula as a complication of infective endocarditis and subsequent complete heart block in a patient with severe anemia. J Community Hosp Intern Med Perspect 2015; 5:29446. [PMID: 26653694 PMCID: PMC4677595 DOI: 10.3402/jchimp.v5.29446] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 09/28/2015] [Accepted: 10/02/2015] [Indexed: 01/16/2023] Open
Abstract
Infective endocarditis has different presentations depending on the involvement of valvular and perivalvular structures, and it is associated with high morbidity and mortality. Aortocavitary fistula is a rare complication. We introduce the case of a 48-year-old female with native valve endocarditis, complicated by aortocavitary fistula to the right atrium, and consequently presented with syncope.
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Affiliation(s)
| | - Irving E Perez
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA;
| | - Pedro A Villablanca
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Harjit Chahal
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Robert Jackson
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Cynthia C Taub
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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11
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Vagnarelli F, Corsini A, Lorenzini M, Pacini D, Ferlito M, Bacchi Reggiani L, Longhi S, Nanni S, Norscini G, Cinti L, Bugani G, Pasquale F, Biagini E, Grigioni F, Di Bartolomeo R, Marini M, Perna GP, Melandri G, Rapezzi C. Acute heart failure in patients with acute aortic syndrome: pathophysiology and clinical-prognostic implications. Eur J Heart Fail 2015. [PMID: 26214747 DOI: 10.1002/ejhf.325] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
AIMS Although acute heart failure (AHF) is a potential complication of acute aortic syndromes (AAS), its clinical details and management implications have been scarcely evaluated. This study aimed to assess prevalence, pathophysiological mechanisms, impact on treatment, and in-hospital mortality of AHF in AAS. METHODS AND RESULTS Data were collected from a prospective AAS registry (398 patients diagnosed between 2000 and 2013). Patients with AHF were identified by the presence of dyspnoea as the presentation symptom or radiological signs of pulmonary congestion or cardiogenic shock, including patients with cardiac tamponade (CT). AHF frequency was 28% (Stanford type A 32% vs. type B 20%, P = 0.01). Four mechanisms leading to AHF were identified, alone or in combination: CT (26%), aortic regurgitation (25%), myocardial ischaemia (17%), and hypertensive crisis (10%). In type A patients, aortic regurgitation and CT were the most frequent mechanisms, whereas myocardial ischaemia and hypertensive crisis were the most frequent in type B patients. Although no difference was noted for diagnostic times, AHF at presentation led to a longer surgical delay in type A AAS. In-hospital mortality was higher in patients with AHF compared with those without (34% vs. 17%, P < 0.001). After multivariable analysis, AHF was associated with increased risk of in-hospital death (adjusted odds ratio 1.97, 95% confidence interval 1.14-3.36, P = 0.014). CONCLUSION AHF occurs in more than a quarter of patients with AAS of both type A and type B, is due to a variety of pathophysiological mechanisms, and is associated with increased surgical delay and in-hospital mortality.
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Affiliation(s)
- Fabio Vagnarelli
- Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Anna Corsini
- Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Massimiliano Lorenzini
- Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Davide Pacini
- Cardiac Surgery, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Marinella Ferlito
- Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Letizia Bacchi Reggiani
- Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Simone Longhi
- Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Samuele Nanni
- Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Giulia Norscini
- Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Laura Cinti
- Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Giulia Bugani
- Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Ferdinando Pasquale
- Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Elena Biagini
- Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Francesco Grigioni
- Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Roberto Di Bartolomeo
- Cardiac Surgery, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Marco Marini
- Cardiology, Cardiovascular Department, 'Ospedali Riuniti di Ancona', Ancona, Italy
| | - Gian Piero Perna
- Cardiology, Cardiovascular Department, 'Ospedali Riuniti di Ancona', Ancona, Italy
| | - Giovanni Melandri
- Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Claudio Rapezzi
- Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Bologna, Italy
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Corciu AI, Fontanive P, Di Cori A, Bongiorni MG. Right heart failure due to a fistula between a giant aortic pseudoaneurysm and the left atrium: a late complication after cardiovascular surgery. J Cardiovasc Med (Hagerstown) 2014; 17 Suppl 2:e196-e198. [PMID: 24933203 DOI: 10.2459/jcm.0000000000000128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
: A 69-year-old woman, treated 5 years before with mechanical aortic valve and vascular prosthesis of ascending aorta implantation for severe aortic regurgitation and dilation of ascending aorta, was referred to our center for dyspnea and peripheral edema. The transthoracic echocardiography showed a giant pseudoaneurysm incorporating the vascular prosthesis and a fistula of it with the left atrium. These findings were confirmed using the transesophageal echocardiogram, cardiac computed tomography, and during cardiac surgery, which was performed 5 days later. The reparative intervention consisted of suturing of both the connections; the patient survived the surgery, but she died 6 weeks later due to infectious complications.
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Affiliation(s)
- Anca I Corciu
- aDepartment of Clinical and Experimental Medicine, University of Pisa bSecond Cardiovascular Department, University Hospital of Pisa, Ospedale Cisanello, Pisa, Italy
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Ahmad T, Chithiraichelvan S, Patil TA, Jawali V. A Rare Complication of Aorto-Left Atrial Fistula after Aortic Valve Replacement and its Management with Intraoperative Transoesophageal Echocardiography. J Cardiovasc Echogr 2013; 23:88-90. [PMID: 28465892 PMCID: PMC5353389 DOI: 10.4103/2211-4122.123956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Aorto-atrial fistula is a rare complication of prosthetic aortic valve replacement and most of them have been diagnosed as a late complication. We present a case of this unusual complication after aortic valve replacement which was diagnosed intraoperatively and this potentially disastrous complication was corrected promptly. Early recognition and diagnosis of this rare surgical complication with intraoperative transoesophageal echocardiography (TEE) is imperative for prompt surgical repair of this lethal defect.
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Affiliation(s)
- Tanveer Ahmad
- Department of Cardiothoracic Surgery, Fortis Hospital, Cunningham Road, Vasanth Nagar, Bangalore, Karnataka, India
| | - Satish Chithiraichelvan
- Department of Cardiac Anaesthesia, Fortis Hospital, Cunningham Road, Vasanth Nagar, Bangalore, Karnataka, India
| | | | - Vivek Jawali
- Department of Cardiothoracic Surgery, Fortis Hospital, Cunningham Road, Vasanth Nagar, Bangalore, Karnataka, India
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Patel V, Fountain A, Guglin M, Nanda NC. Three-dimensional transthoracic echocardiography in identification of aorto-right atrial fistula and aorto-right ventricular fistulas. Echocardiography 2011; 27:E105-8. [PMID: 20584055 DOI: 10.1111/j.1540-8175.2010.01225.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
We report the case of a 72-year-old woman who developed new onset right ventricular failure after redo aortic valve replacement. The diagnosis of left to right shunt was initially made using two-dimensional transthoracic echocardiography (2DTTE) and 2D transesophageal echo with color Doppler (TEE). Definite diagnosis of aorto-right atrial and aorto-right ventricular fistula was made using three-dimensional transthoracic echocardiography (3DTTE) with color flow Doppler imaging. Early recognition and diagnosis of this rare surgical complication is imperative for prompt surgical repair of this lethal defect. 3DTTE should be utilized in cases of new onset heart failure with unclear etiology to diagnose unusual causes of this potentially fatal condition.
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Affiliation(s)
- Vinod Patel
- Department of Cardiology, University of South Florida, Tampa, Florida, USA.
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Azran MS, Fischer S, Guyton RA, Whitley WS. Early detection of aortic root to left atrial fistula after aortic valve replacement. Anesth Analg 2010; 112:532-4. [PMID: 21127280 DOI: 10.1213/ane.0b013e3182050e8e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Marc S Azran
- Department of Anesthesiology, Emory University School of Medicine, 1364 Clifton Rd., Atlanta, GA 30322, USA.
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El Yaman MM, Ammash NM, Espinosa RE, Menon SC, Cetta F. Successful Transcatheter Closure of an Aorto-Left Atrial Fistula. CONGENIT HEART DIS 2007; 2:446-50. [DOI: 10.1111/j.1747-0803.2007.00141.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hernández-García JM, Alonso-Briales JH, Jiménez-Navarro MF, Cabrera-Bueno F, González-Cocina E, Such-Martínez M. Cierre percutáneo de una fístula entre aorta y aurícula izquierda mediante dispositivo Amplatzer. Rev Esp Cardiol 2005. [DOI: 10.1157/13078559] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Januzzi JL, Eagle KA, Cooper JV, Fang J, Sechtem U, Myrmel T, Evangelista A, Oh JK, Llovet A, O'Gara PT, Nienaber CA, Isselbacher EM. Acute Aortic Dissection Presenting With Congestive Heart Failure: Results From the International Registry of Acute Aortic Dissection. J Am Coll Cardiol 2005; 46:733-5. [PMID: 16098446 DOI: 10.1016/j.jacc.2005.05.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Ananthasubramaniam K. Clinical and echocardiographic features of aorto-atrial fistulas. Cardiovasc Ultrasound 2005; 3:1. [PMID: 15655075 PMCID: PMC546197 DOI: 10.1186/1476-7120-3-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2004] [Accepted: 01/17/2005] [Indexed: 12/23/2022] Open
Abstract
Aorto-atrial fistulas (AAF) are rare but important pathophysiologic conditions of the aorta and have varied presentations such as acute pulmonary edema, chronic heart failure and incidental detection of the fistula. A variety of mechanisms such as aortic dissection, endocarditis with pseudoaneurysm formation, post surgical scenarios or trauma may precipitate the fistula formation. With increasing survival of patients, particularly following complex aortic reconstructive surgeries and redo valve surgeries, recognition of this complication, its clinical features and echocardiographic diagnosis is important. Since physical exam in this condition may be misleading, echocardiography serves as the cornerstone for diagnosis. The case below illustrates aorto-left atrial fistula formation following redo aortic valve surgery with slowly progressive symptoms of heart failure. A brief review of the existing literature of this entity is presented including emphasis on echocardiographic diagnosis and treatment.
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