Aortico-Cameral Communication from Left Sinus Valsalva Aneurysm to Right Atrium via a Tortuous Tunnel with Aneurysmal Dilatation

Aorto‐Right Atrial Fistula Following Transseptal Catheterization and Catheter Ablation for Atrial Fibrillation

“…Infrequently reported symptoms of aorto‐atrial fistula include recurrent respiratory tract infections and angina 11 . The hallmark physical examination finding is a continuous murmur best heard near the upper‐right sternal border 4–6,8,11 . In our case, diagnostic procedures performed before the second RFA procedure did not show any evidence of an aorto‐cameral fistula making a congenital etiology unlikely.…”

“…Aorto‐cameral fistula, either congenital or acquired, is an abnormal communication between ascending aorta and 1 of the cardiac chambers. In our review, most cases of congenital aorto‐cameral fistulas were discovered in childhood presenting with symptomatic ventricular strain 6 or a continuous murmur noted on routine cardiopulmonary examination 7,8 . However, Akar et al 9 described a case of incidental congenital aorto‐right atrial fistula in a 57‐year‐old male being evaluated for unstable angina with 3‐vessel coronary artery disease.…”

“…11 The hallmark physical examination finding is a continuous murmur best heard near the upperright sternal border. [4][5][6]8,11 In our case, diagnostic procedures performed before the second RFA procedure did not show any evidence of an aorto-cameral fistula making a congenital etiology unlikely. The patient had undergone 2 RFA procedures at an outside tertiary care center.…”

“…In our review, most cases of congenital aorto-cameral fistulas were discovered in childhood presenting with symptomatic ventricular strain 6 or a continuous murmur noted on routine cardiopulmonary examination. 7,8 However, Akar et al 9 described a case of incidental congenital aorto-right atrial fistula in a 57-year-old male being evaluated for unstable angina with 3-vessel coronary artery disease. Clinical presentation of aorto-atrial fistula includes heart failure, exertional dyspnea, 6,11 palpitations, 6,11 and incidental murmur.…”

Aortico-right atrial tunnel in an adult patient

“…Up to now, only ten cases regarding ARAT were reported [1][2][3][4][5][6]. In most of the reported cases, the tunnel originated from the left sinus of Valsalva whereas the tunnel in one case originated from the non-coronary sinus, and in other case from the right coronary sinus.…”