Transesophageal color flow Doppler features of aorta to right ventricle fistula

Transcatheter closure of an acquired post-operative aorta to right ventricle shunt in a child with complex univentricular heart

KONAR-Multifunctional^TM VSD Occluder (Lifetech, Shenzhen, China) is one of the most recent additions to the armamentarium of device closure interventions offering special features to tackle complex cardiac anatomies. Herein, we report the first use of the KONAR-MFO in an 8.5-year-old female patient (27 kg/129 cm) with stage III palliated univentricular heart to close an acquired post-operative tunnel-like communication (5 mm long × 2.6 mm large) between the right anterior non-coronary aortic sinus and the rudimentary right ventricular cavity. The shunt was diagnosed two and a half years after bulboventricular foramen surgical enlargement. The 5× 3 mm KONAR-MFO was retrogradely implanted under ultrasound and biplane fluoroscopic guidance. Immediate and 12-month follow-up confirmed successful outcomes with complete shunt closure and preserved aortic valve competence.

Aorta-to-right ventricle neoshunt closure using an Amplatzer Duct Occluder II device

We report the case of a 22-year-old female patient with complex congenital heart disease and multiple cardiac surgeries who came to our attention for right heart failure and hemolysis 3 years after aortic valve replacement surgery. She was diagnosed with aorta-to-right ventricle fistula and was efficiently treated with retrograde implantation of an Amplatzer Duct Occluder II device using three-dimensional multimodality fusion imaging.

Chronic aorto-right ventricular fistula following penetrating cardiac injury: A case report

Aorto-cardiac fistula is a rare but potentially life-threatening condition. We herein report a rare case of chronic aorto-right ventricular fistula formation secondary to a stab penetrating injury to the heart and aorta occurred 15 years ago. The aorto-right ventricular fistula was not found until 15 years after the incident. The fistula had been repaired successfully to prevent further deterioration of cardiac function. Here, we report the clinical presentation, diagnosis and treatment strategies of the aorto-right ventricular fistula, and discuss the possible etiology of the development of the fistula after the penetrating injury.

A case of aortic dissection with fistula from aorta to right ventricle

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.

Transcatheter closure of an iatrogenic aorto-right ventricular fistula

Aortocardiac fistulas are rare, especially if they develop after an aortic valve replacement surgery. We report the case of a 54-year-old male submitted to aortic valve replacement and implantation of an ascending aortic prosthetic graft, complaining of exertional dyspnea, who was found to have significant shunt between the aortic root and right ventricle (RV), and de novo moderate pulmonary hypertension. At the catheterization laboratory, the left-to-right shunt was confirmed (Qp:Qs = 1.9:1). Contrast angiography of the ascending aorta showed a significant flow into the right ventricular cavity, and the fistulous tract was then measured, inflating a Tyshak II balloon of 10 × 20 mm (NuMED, Hopkinton, New York), until achieving a complete interruption of flow. Minimal diameter of the defect was 4.9 mm. Percutaneous closure of the aorto-RV shunt was performed under general anesthesia and transesophageal echocardiogram and fluoroscopic guidance. Using a venous and an arterial femoral access, a 0.035″ hydrophilic guide-wire crossed the defect between the aorta and RV, creating an arteriovenous loop. Then, using a 7F Delivery System 45° (AGA medical corporation, Golden Valley, MN) an Amplatzer Duct Occluder(®) (AGA Medical Corporation) 8/6 mm was advanced and released within the defect, achieving an almost complete closure of the fistulous tract.

Percutaneous closure of a para-prosthetic aorto-right ventricular fistula

A 60-year-old woman with increasing dyspnea was found to have a para-prosthetic aorto-right ventricular fistula during post-operative evaluation. Due to her multiple sternotomies, she was considered to be high risk for open surgical repair and referred for percutaneous intervention. A 6/4 mm Amplatzer occluder device (AGA Medical, Golden Valley, MN) was successfully delivered across the fistula with excellent immediate angiographic results.

Aortobiventricular fistulas associated with pseudoaneurysm of the ascending aorta 12 years after patch repair of supravalvular aortic stenosis

Fistula formation between the aorta and cardiac chamber is a rare complication of the ascending aortic aneurysm. A 27 year-old man undergoing successful patch aortoplasty for supravalvular aortic stenosis 12 years before admission had a high fever, infectious signs in blood laboratory data, and congestive heart failure. Transthoracic and transesophageal echocardiography revealed a pseudoaneurysm of the aortic root and aortobiventricular fistulas. Detachment of the proximal end of the aortic patch was thought to be the cause of the pseudoaneurysm. Debridement of necrotic tissue surrounding fistulas produced large defects in the anterior wall of the right ventricle, interventricular septum, and ascending aorta. A modified Konno operation effectively reconstructed the outflow tracts of both ventricles and the aorta.

Diagnosis and management of traumatic aorto-right ventricular fistulas

BACKGROUND

Traumatic aorto-right ventricular (Ao-RV) fistulas are rare lesions that result in congestive heart failure if left untreated. Early diagnosis and prompt surgical intervention are required to avoid the natural outcome of cardiac decompensation.

METHODS

All cases of traumatic Ao-RV fistula described in the English literature since 1958 were reviewed. The clinical presentation, methods of diagnosis, and treatment strategies were assessed to determine the pathophysiology, natural history, and outcome of surgical intervention.

RESULTS

Forty cases of traumatic Ao-RV fistulas were described in the English literature. There were 39 men and 1 woman, with a mean age of 28.3 years (range, 15 to 50 years). Twenty-two (55%) patients had isolated Ao-RV fistulas. Fourteen (35%) had Ao-RV fistulas with aortic insufficiency. Definitive surgical repair was performed in 38 patients. The associated aortic valve injuries were managed with repair techniques or replacement with prosthetic devices. The surgical outcomes in all patients were satisfactory.

CONCLUSIONS

The pathophysiology and natural history of Ao-RV fistulas involves the development of congestive heart failure. Traumatic aortic insufficiency frequently is associated with this disorder. Early diagnosis and prompt treatment are necessary to avoid the natural outcome of cardiac decompensation. Definitive repair should be performed with the aid of cardiopulmonary bypass during the same hospitalization.

Ventricular Septal Defect Masquerading as Severe Tricuspid Regurgitation: A Case Report and Literature Review

Two-dimensional echocardiography (2-D) is a useful technique for noninvasive evaluation cardiac structure, function, and hemodynamics; however, multiple factors may limit the technical adequacy of the 2-D examination. In this article, we present the case of a ventricular septal defect to right atrial shunt, which was misinterpreted as severe tricuspid regurgitation secondary to severe pulmonary hypertension, despite the absence of right ventricular enlargement or hypertrophy. A transesophageal echocardiography (TEE) examination was performed to explain the discrepancy between the 2-D and Doppler findings, the results of which are discussed, along with a review of the literature.