Aorto-right ventricular fistula as an occasional finding

Walpot, Jeroen; Klazen, Cees; Hokken, Raymond B.; Sorgedrager, Jetze; Hoevenaar, Martha; Braber, Judith den

doi:10.1016/j.euje.2004.08.009

Cited by 13 publications

(11 citation statements)

References 5 publications

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“…Rupture of sinus of Valsalva aneurysm into the cardiac chambers is a complication which predominantly affects males [3,4]. When aneurysms arise in the right coronary sinus, they mostly communicate with the right atrium, as was the case of our patient [3].…”

Section: Discussionmentioning

confidence: 85%

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Surgical Repair of a Sinus of Valsalva Aneurysm Ruptured into the Right Atrium Diagnosed After a Non-Penetrating Chest Trauma

Hela¹

2016

ETS

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Aorto-right atrial fistulas are lesions that result in heart failure if they are untreated. They result from rupture of congenital or acquired aortic aneurysms into the right atrium.We report an unusual case of fistula from aneurysmal right sinus of Valsalva to the right atrium discovered after a non-penetrating trauma and treated surgically. Case PresentationA 37 year-old-man, with no past medical history, was a victim of a closed chest trauma by falling in a hole whose depth was 20 meters. He was admitted to the emergency department with stable vital signs. He had mandibular fractures. Cerebral CT scan showed no anomalies. Systolic blood pressure was 131 mm Hg, diastolic blood pressure was 40 mm Hg. The patient had dyspnea. There was an ecchymosis on the chest wall. A thrill was appreciated over the precordium.Heart auscultation revealed a continuous murmur on the aortic site. A chest roentgenogram revealed an increased cardiac silhouette with bilateral alveolar opacities. There was a sinus tachycardia on the electrocardiogram, without ischemic signs or conduction disorders. A two-dimensional echocardiography revealed an important left to right shunt with a continuous flow from the aorta to the right atrium, with an aneurysm of the right sinus of Valsalva. The aneurysm was next to the right coronary artery. The aortic valve was without anomalies, and the right heart chambers were dilated. The echocardiography showed no other congenital heart diseases.Thoracic CT scan detected a bilateral pulmonary edema with a mild pleural effusion. So, the patient underwent emergent surgical repair. A median sternotomy was performed. The pericardium was opened. A continuous thrill along the aorta was palpated.Cardiopulmonary bypass was established between the aorta and two vena cavae. The intra-operative examination didn't find any hematoma around the sinus of Valsalva which was dilated. A fistula between the right sinus of Valsalva and the right atrium at the level of the right coronary artery was observed through a transverse aortotomy. This defect had 2 cm of diameter. There was no injury of the aortic valve. The defect was closed with a synthetic patch sutured with pledgeted sutures from inside the right coronary sinus at the level of the right coronary artery into the atrial wall (Figure 1).After surgery, the patient's recovery was uneventful and the patient was discharged on the fifth postoperative day. The patient remains asymptomatic and without murmurs 2 months after the surgery. DiscussionAneurysmal dilatation of the sinus of Valsalva is a cardiac anomaly caused by infective endocarditis, syphilitic aortitis, atherosclerosis, connective tissue disease or as a congenital abnormality discovered incidentally [1,2].Rupture of sinus of Valsalva aneurysm into the cardiac chambers is a complication which predominantly affects males [3,4]. When In this case report, we describe a case of a ruptured aneurysm of the sinus of Valsalva ruptured into the right atrium discovered incidentally after a non-penetrating chest trauma in...

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Section: Discussionmentioning

confidence: 85%

“…Rupture of sinus of Valsalva aneurysm into the cardiac chambers is a complication which predominantly affects males [3,4]. When In this case report, we describe a case of a ruptured aneurysm of the sinus of Valsalva ruptured into the right atrium discovered incidentally after a non-penetrating chest trauma in a 37-year-old patient.…”

Section: Discussionmentioning

confidence: 96%

Surgical Repair of a Sinus of Valsalva Aneurysm Ruptured into the Right Atrium Diagnosed After a Non-Penetrating Chest Trauma

Hela¹

2016

ETS

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“…ARV fistulas are defined anatomically as defects of the aortic wall in the area above the right coronary cusp, where it separates aorta and the right ventricular outflow tract [4] . In general, ARV fistulas have been described to occur because of rupture of congenital and acquired sinus of Valsalva aneurysms.…”

Section: Discussionmentioning

confidence: 99%

Aorto-right ventricular fistula: An early complication of aortic valve replacement

Triki

Kahla

Hammami

et al. 2015

CRIM

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The implantation of prosthetic heart valves has been associated with several kinds of complications, but the description of aorto-right ventricle (ARV) fistula as a complication of aortic valve replacement is a very rare finding. We report herein the case of a 56-year-old woman sought care for palpitations two months after prosthetic aortic and mitral valve replacement. Cardiac examination revealed normally audible mechanical sounds with a new loud to-and-fro murmur with continuous precordial thrill. Thyroid function tests were poorly balanced (raised FT4 and lowered TSH). Electrocardiography at admission displayed rapid heart rhythm with atrial fibrillation. Trans-thoracic echocardiography (TTE) revealed left-to-right shunt due to aorto-RV fistula. We discuss then the aetiology, diagnosis and management of this rare para-valvular leakage.

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“…We present two cases of Sinus of Valsalva aneurysms 1 with aorta to right heart fistulae 2 demonstrating similar underlying pathology but substantial differences in 3D flow characteristics and systemic to pulmonary flow distribution. A 64-year-old male (case 1) was incidentally noted to have a heart murmur.…”

mentioning

confidence: 90%

“…Rare complications are aorto-cardiac fistulae, often infective or traumatic in etiology usually secondary to a ruptured SoV aneurysm 2 . Despite similar cardiac anomaly, 3D blood flow visualization revealed intricate differences in flow patterns connecting the systemic and pulmonary circulation.…”

mentioning

confidence: 99%

Complex 3D blood flow pathways in two cases of aorta to right heart fistulae: a 4D flow MRI study

Thakrar

Popescu

Gupta

et al. 2013

Magnetic Resonance Imaging

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We present an analysis of 3D blood flow in two cases of Sinus of Valsalva to right heart fistulae based on 4D flow MRI. Despite similar underlying pathology, 3D visualization revealed intricate differences in flow patterns connecting the systemic and pulmonary circulation. The cases illustrates the potential of 4D flow MRI to complement the evaluation of complex structural heart disease by assessing complex flow dynamics and providing quantitative information of flow ratios and flow rates.

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Aorto-right ventricular fistula as an occasional finding

Cited by 13 publications

References 5 publications

Surgical Repair of a Sinus of Valsalva Aneurysm Ruptured into the Right Atrium Diagnosed After a Non-Penetrating Chest Trauma

Surgical Repair of a Sinus of Valsalva Aneurysm Ruptured into the Right Atrium Diagnosed After a Non-Penetrating Chest Trauma

Aorto-right ventricular fistula: An early complication of aortic valve replacement

Complex 3D blood flow pathways in two cases of aorta to right heart fistulae: a 4D flow MRI study

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