Clinical and echocardiographic features of aorto-atrial fistulas

Abstract

Aorto-atrial fistulas (AAF) are rare but important pathophysiologic conditions of the aorta and have varied presentations such as acute pulmonary edema, chronic heart failure and incidental detection of the fistula. A variety of mechanisms such as aortic dissection, endocarditis with pseudoaneurysm formation, post surgical scenarios or trauma may precipitate the fistula formation. With increasing survival of patients, particularly following complex aortic reconstructive surgeries and redo valve surgeries, recognition of this complication, its clinical features and echocardiographic diagnosis is important. Since physical exam in this condition may be misleading, echocardiography serves as the cornerstone for diagnosis. The case below illustrates aorto-left atrial fistula formation following redo aortic valve surgery with slowly progressive symptoms of heart failure. A brief review of the existing literature of this entity is presented including emphasis on echocardiographic diagnosis and treatment.

Pseudoaneurysm of the Ascending Aorta With Perforation Into the Left Atrium Presenting as Acute Heart Failure

“…1-3 Rupture of false or true aneurysm into the cardiac chamber and fistula formation after surgery are rare late-phase complications. Although there is a case report of pseudoaneurysm of the ascending aorta with aorto-right atrium fistula, 4 there are no case reports on fistulous communication to the LA (such as in the current case), presenting as severe acute heart failure.…”

Aortic root to left-atrial fistula after aortic valve replacement: A rare complication and its intraoperative management

“…[3] This complication has been rarely diagnosed in the early post-operative period after AVR. [4] Risk factors described include infected tissue before valve replacement, connective tissue abnormalities, extensive aortic annular debridement, and oversized aortic prostheses. [3] Various case reports describe late presentation of similar complications in patients who survived long.…”

Aorto-Right Atrial Fistula After Bentall Repair

“…Transthoracic echocardiograms have been reported to detect fi stulous tracts in ∼50% of cases, but the detection rate is increased to ∼97% with the addition of transesophageal echocardiograms with Doppler (14). Additionally, due to its ability to delineate cardiac structures in unconventional views, three-dimensional echocardiography is becoming an increasingly useful tool in fi stula detection (12).…”