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

Severe obstructive sleep apnoea, aortic dissection and aortopulmonary fistula in a 56-year-old patient with syncope

We present a case of a 56-year-old patient with obstructive sleep apnoea (OSA) presenting with acute decompensated heart failure and signs of cardiogenic shock. Echocardiography and CT imaging led to the diagnosis of acute type A aortic dissection (AD) complicated by aortopulmonary fistula (APF). The patient underwent successful surgical repair with complicated postoperative course including pulseless electrical activity arrest. This case highlights the underappreciated role of untreated OSA as a risk factor for AD. Furthermore, it presents an opportunity to review APFs as a rare complication of AD. We discuss the available evidence linking OSA and AD, review currently reported cases of APF, briefly outline the haemodynamics of this acute left-to-right shunt and discuss management of this rare but deadly complication.

Aorta-cameral fistulas: Spectrum of CT findings and review

Aorto-cameral fistula (ACF) is an uncommon entity, defined as an abnormal communication between the aorta and a cardiac chamber. The most common causes include ruptured sinus of Valsalva aneurysm, infective endocarditis, traumatic injury, aortic dissection, or rarely can be iatrogenic in nature. While smaller communications may initially be asymptomatic, the natural course of these connections is generally refractory heart failure as they do not spontaneously heal. Larger fistulas can be life threatening with high mortality rates, and therefore once recognized, surgery is generally considered the treatment of choice. Diagnosis, however, can be challenging, and various imaging modalities are often used for diagnosis. This review highlights common underlying etiologies, clinical manifestations, and radiologic imaging appearances of ACF to each of the cardiac chambers of this uncommon, but clinically important entity, with emphasis on CT.

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.

Surgical Repair of a Giant Aorto-Left Ventricular Fistula

Aortoventricular fistula, a rare congenital or acquired defect of the aortic wall, is characterized by an abnormal connection between the aorta and one of the ventricles. Symptom severity correlates with the diameter of the fistula and with the acute or chronic timing of presentation. The diagnosis is usually made by using echocardiography, and surgical treatment is necessary to avoid progression to heart failure. We describe the case of a 27-year-old woman who underwent successful surgical repair of an aortoventricular fistula that originated from the right coronary sinus and extended into the left ventricle through the interventricular septum. In addition to the patient's case, we briefly discuss this unusual condition.

Congenital Aorto-Right Ventricular Fistula Associated with Pulmonary Hypertension in an Old Female Patient

We report a late clinical presentation of an aorto-right ventricular fistula (RVF) extending from the right sinus of Valsalva into the RV outflow tract with significant left-to-right shunt and severe pulmonary hypertension. A three-dimensional transesophageal echocardiogram and a chest-computed tomography scans were performed to better characterize the abnormality. Aorto- RVF can be either congenital or acquired, secondary to endocarditis, Valsalva aneurysm rupture, chest trauma, or aortic dissection.

Aortocavitary fistula as a complication of infective endocarditis and subsequent complete heart block in a patient with severe anemia

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.

Aorto-right atrial fistula: Late complication of tricuspid valve infective endocarditis

Abnormal connections between the ascending aorta and the cardiac chambers are rare, especially in the context of right-sided infective endocarditis (IE). Transthoracic echocardiography (TTE) with color-flow Doppler, transesophageal echocardiography (TEE), or both may be required for diagnosis. We present the case of a woman admitted with right-sided heart failure (HF) symptoms. She had a previous history of tricuspid valve IE 30 years ago. TTE and TEE revealed an aorto-right atrium fistula located just under the non-coronary cusp into the right atrium at the level of the previously affected tricuspid valve. The Patient refused surgery and was discharged home on HF medications. She has been stable for the last 3 years. The peculiarity of this case is the late symptomatic presentation of the aorto-atrial fistula and the unusual association to tricuspid valve IE.