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Kitada Y, Arakawa M, Miyagawa A, Okamura H. Acute type A aortic dissection complicated with an aorto-right atrial fistula. JTCVS Tech 2020; 1:1-3. [PMID: 34317695 PMCID: PMC8288752 DOI: 10.1016/j.xjtc.2020.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 10/01/2019] [Accepted: 01/03/2020] [Indexed: 11/27/2022] Open
Affiliation(s)
- Yuichiro Kitada
- Department of Cardiovascular Surgery, Nerima Hikarigaoka Hospital, Tokyo, Japan
| | - Mamoru Arakawa
- Department of Cardiovascular Surgery, Nerima Hikarigaoka Hospital, Tokyo, Japan
| | - Atsushi Miyagawa
- Department of Cardiovascular Surgery, Nerima Hikarigaoka Hospital, Tokyo, Japan
| | - Homare Okamura
- Department of Cardiovascular Surgery, Nerima Hikarigaoka Hospital, Tokyo, Japan
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2
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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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Kalra A, Kohl LP, Asinger RW, Bachour FA, Van Camp JR, Ayenew W, Bart BA. Aorto-right atrial fistula at aortotomy site following surgical myectomy. Echocardiography 2013; 30:E300-1. [PMID: 24028475 DOI: 10.1111/echo.12371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Ankur Kalra
- Sections of Cardiology and Cardio-Thoracic Surgery, Departments of Medicine and Surgery, Hennepin County Medical Center, Minneapolis, Minnesota
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Park H, Park TH, Lee DY, Ahn J, Baek HK, Kim MH, Kim YD, Park KJ, Wu JS. A case of aortic dissection with fistula from aorta to right ventricle. Korean Circ J 2012; 42:629-31. [PMID: 23091509 PMCID: PMC3467448 DOI: 10.4070/kcj.2012.42.9.629] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 01/03/2012] [Accepted: 01/27/2012] [Indexed: 12/12/2022] Open
Abstract
Aorto-right ventricular fistula is a very rare complication of aortic dissection. We report a case of acute aortic dissection extending into the right ventricle as documented by echocardiography. The patient survived after successful surgical repair.
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Affiliation(s)
- Hyekyong Park
- Division of Cardiology, Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
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Harada M, Hirai H, Lee T, Inoue T, Sakai H, Sugiyama Y, Suzuki M, Yamaguchi T. A case of chronic dissecting aortic aneurysm complicated with rupture into the right atrium: Diagnosis by transesophageal echocardiography. J Med Ultrason (2001) 2002; 29:63-9. [PMID: 27277742 DOI: 10.1007/bf02481441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Although rupture of a dissecting aortic aneurysm into the pericardial sac, pleural cavities, or mediastinum is a frequently encountered complication of this entity, rupture into a right-sided cardiac chamber is extremely rare. An 80-year-old woman was admitted to this institution because of dyspnea and facial edema. One year before admission, a diagnosis of dissecting aortic aneurysm (Stanford A type) was made based on results of magnetic resonance imaging and transesophageal echocardiography (TEE); however, the patient and her family refused surgical therapy. On admission, blood pressure was 120/60 mmHg, and a Levine 3/6° continuous murmur was audible at the third and fourth intercostal spaces of the right sternal border. Chest x-ray film showed moderate cardiomegaly, congested lung fields, and bilateral pleural effusion. A two-dimensional echocardiogram revealed severe aortic root dilatation 80 mm in diameter with the intimal flap. Color flow Doppler imaging demonstrated abnormal flow toward the back space in dilated ascending aorta. Continuous wave Doppler imaging showed the peak velocity of this flow to be 4.8 m/s. This high-velocity flow strongly suggested that the dissecting aortic aneurysm had ruptured into the right-sided cardiac chamber, and shunt flow from the false lumen of the aortic aneurysm into the right atrium was directly visualized by TEE. Our diagnosis, based on these findings, was chronic dissecting aortic aneurysm with communication into the right atrium. In view of the patient's deteriorating clinical condition, cardiac catheterization was not performed before surgery. Surgery revealed an aneurysm of the ascending aorta measuring 90 mm in diameter and multiple fistulas approximately 2 to 3 mm in diameter arising from the false lumen of the aorta into the right atrium at the base of the atrial appendage. The patient underwent successful replacement of the ascending aorta and closure of the aorto-right atrial fistulas. She had an uneventful postoperative course and was discharged 7 weeks after surgery.
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Affiliation(s)
- Masahiko Harada
- Third Department of Internal Medicine, Toho University School of Medicine, Ohashi Hospital, 2-17-6, Ohashi Meguro-ku, 153-8515, Tokyo, Japan
| | - Hironori Hirai
- Third Department of Internal Medicine, Toho University School of Medicine, Ohashi Hospital, 2-17-6, Ohashi Meguro-ku, 153-8515, Tokyo, Japan
| | - Tetsuo Lee
- Third Department of Internal Medicine, Toho University School of Medicine, Ohashi Hospital, 2-17-6, Ohashi Meguro-ku, 153-8515, Tokyo, Japan
| | - Takuya Inoue
- Third Department of Internal Medicine, Toho University School of Medicine, Ohashi Hospital, 2-17-6, Ohashi Meguro-ku, 153-8515, Tokyo, Japan
| | - Hideyuki Sakai
- Third Department of Internal Medicine, Toho University School of Medicine, Ohashi Hospital, 2-17-6, Ohashi Meguro-ku, 153-8515, Tokyo, Japan
| | - Yuko Sugiyama
- Third Department of Internal Medicine, Toho University School of Medicine, Ohashi Hospital, 2-17-6, Ohashi Meguro-ku, 153-8515, Tokyo, Japan
| | - Makoto Suzuki
- Third Department of Internal Medicine, Toho University School of Medicine, Ohashi Hospital, 2-17-6, Ohashi Meguro-ku, 153-8515, Tokyo, Japan
| | - Tetsu Yamaguchi
- Third Department of Internal Medicine, Toho University School of Medicine, Ohashi Hospital, 2-17-6, Ohashi Meguro-ku, 153-8515, Tokyo, Japan
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6
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Nakano H, Takahara Y, Sudou Y, Shioiri M, Nakajima N. Aortic dissection complicated with aorto-right atrium fistula. THE JAPANESE JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY : OFFICIAL PUBLICATION OF THE JAPANESE ASSOCIATION FOR THORACIC SURGERY = NIHON KYOBU GEKA GAKKAI ZASSHI 2000; 48:531-3. [PMID: 11002587 DOI: 10.1007/bf03218193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Aorto-right atrium fistula associated with aortic dissection is a very rare complication. Here report a case of successful surgical repair of ascending aortic dissection complicated with aorto-right atrium fistula. A 65-year-old man was presented with sudden chest pain and dyspnea. Fifteen years ago, he had aortic valve replacement. An aortic dissection with fistula to the right atrium was diagnosed by echocardiography and cardiac catheterization. At operation, dense adhesion of the aortic root due to the previous cardiac operation was confirmed, and this was suggested as the cause for this rare complication.
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Affiliation(s)
- H Nakano
- Division of Cardiovascular Surgery, Funabashi Municipal Medical Center, Japan
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7
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Abstract
The development of a fistula between the aorta and right atrium is a rare complication of ascending aortic dissection and has a high mortality if not diagnosed and surgically treated. Clinical diagnosis is best supported by specialised imaging. In addition it may present technically very challenging problems. We report the first case which follows aortic root replacement for an acute type A dissection. Aorto-right atrial fistula (AoRAF) rarely complicates ascending aortic dissection. We report the first case to follow corrective surgery for aortic dissection.
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Affiliation(s)
- D A Chung
- Department of Cardiothoracic Surgery, Papworth Hospital, Papworth Everard, Cambridgeshire CB3 8RE, England, UK
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Caruso A, Iarussi D, Materazzi C, Dialetto G, Covino F, Bossone E, Cotrufo M. Aortic dissection with fistula to right atrium after heart transplantation: diagnosis by transthoracic and transesophageal echocardiography. Echocardiography 2000; 17:337-40. [PMID: 10979003 DOI: 10.1111/j.1540-8175.2000.tb01146.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Aortic dissection with rupture into the right atrium is an extremely rare and rapidly fatal condition that may occur after cardiac surgery. We report the case of a 59-year-old woman with a 6-year history of heart transplantation who presented with subacute illness characterized by chest pain and severe cardiac decompensation accompanied by a continuous murmur in the precordium. The diagnosis of aortic dissection complicated by right atrial fistula was made by the combination of transthoracic and transesophageal echocardiographic examination.
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Affiliation(s)
- A Caruso
- Istituto Medico Chirurgico di Cardiologia, Seconda Università, Ospedale Monaldi, Naples, Italy
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9
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Abstract
The false channel of an aortic dissection only rarely ruptures into a cardiac chamber producing an aorto-cameral fistula. Reports of 20 cases have been published, and two distinct clinical patterns have emerged. In nine patients, severe cardiac decompensation associated with chest pain developed abruptly months to years after coronary bypass graft surgery or aortic valve replacement. Continuous murmurs were observed infrequently. In 11 patients, progressive chronic or subacute congestive heart failure developed in patients with aortic dissection known or suspected to have occurred months to years previously. A continuous murmur was almost always present. The frequency with which aortocameral fistula occurred in patients who had undergone cardiac surgery suggests a pathogenetic mechanism. It seems probable that postoperative adhesions favor fistula over free rupture.
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Affiliation(s)
- J Lindsay
- Division of Cardiology, Washington Hospital Center, DC 20010
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10
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Henze AC, Thorelius JB, Borowiec JW, Enghoff EH, Thurén JB. Ascites after rupture of dissecting aortic aneurysm into the right atrium. Ann Thorac Surg 1991; 51:125-7. [PMID: 1985552 DOI: 10.1016/0003-4975(91)90468-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We report successful repair of an aneurysmal aorta-right atrial fistula causing intractable ascites. The clamped "ascending aorta" was drained for mixed return after perfusion through the femoral vessels and opened during hypothermic arrest. Return cannulation through the fistula permitted definitive repair.
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Affiliation(s)
- A C Henze
- Department of Thoracic and Cardiovascular Surgery, University Hospital, Uppsala, Sweden
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Vaidiyanathan D, Meenakshi K, Elangovan S, Jayachandran J, Chokalingam V, Hussain AT, Alagesan R. Aortic dissection with a fistulous communication into the right atrium: a case report. Angiology 1990; 41:1086-9. [PMID: 2278406 DOI: 10.1177/000331979004101211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A case of aortic dissection (type 1, De Bakey) with a rent into the right atrium (RA), diagnosed by echocardiography (echo) and confirmed by aortography, is reported. The patient presented with cardiac failure and a continuous murmur in the right second and third intercostal spaces. The patient has survived for two years with medial treatment.
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Affiliation(s)
- D Vaidiyanathan
- Department of Cardiology, Government General Hospital, Madras, India
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12
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Davies NJ, Butany J, Yock PG, Rakowski H. Aortic dissection and rupture that produce right ventricular perforation: detection by echocardiography and color flow mapping. J Am Soc Echocardiogr 1990; 3:140-4. [PMID: 2334544 DOI: 10.1016/s0894-7317(14)80508-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Aorta to right ventricular fistula is a rare complication of ascending aortic dissection that has previously been diagnosed ante mortem only by cardiac catheterization. This report describes a patient who had aorta to right ventricular fistula that caused a left-to-right shunt and marked hemodynamic instability. An anatomic diagnosis was made rapidly in this patient by use of echocardiographic techniques. Two-dimensional and Doppler echocardiography have an important role in defining the cause of cardiovascular collapse after aortic dissection.
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Affiliation(s)
- N J Davies
- Division of Cardiology, Toronto General Hospital, Canada
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