Percutaneous transcatheter closure of aorto-right ventricular fistula using the Amplatzer duct occluder

Abstract

The occurrence of aorto-right ventricular fistula after an aortic valve replacement is rare. If it remains untreated, this condition can result in heart failure and could thus significantly compromise patient survival. Surgical closure is the treatment of choice; however, transcatheter closure has been attempted with relatively acceptable results. Here, we report on a patient who presented with heart failure with an aorto-right ventricular fistula that was present for nine years following aortic valve replacement. Successful transcatheter closure of the fistula with the use of the Amplatzer duct occluder was performed, suggesting that the percutaneous approach is an efficient technique for the treatment of such fistulae.

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

“…The device was perfectly fitted across the tunnel achieving complete shunt closure and patient clinical recovery. To our knowledge, this is the second report of aorta‐to‐RV fistula retrograde closure 7 . The tunnel was easily accessed from the aorta using proper wires and the ADO II device was promoted directly through the RV to the fistula and the aorta with three‐dimensional multimodality fusion imaging.…”

“…Aorta‐to‐RV fistula has been most commonly seen after rupture of sinus of Valsalva aneurysm, trauma, or as a complication of infective endocarditis and aortic dissections 1–3 . These lesions have been very rarely described following transcatheter or surgical aortic valve replacements and ventricular septal defect repairs 4–8 . Postoperative pericardial adhesions may prevent free aortic rupture into the pericardial space, increasing the predisposition to penetrate neighboring cardiac cavities, such as the RV.…”

“…Our patient was considered a high‐risk surgical candidate with a history of repeated cardio‐thoracic surgeries making the percutaneous approach an appealing treatment option. The devices used for similar interventions include coils, and various devices from the Amplatzer family 1,7,8 . Based on the literature review and our own experience, ADO II was the most suitable device.…”

“…[1][2][3] These lesions have been very rarely described following transcatheter or surgical aortic valve replacements and ventricular septal defect repairs. [4][5][6][7][8] Postoperative pericardial adhesions may prevent free aortic rupture into the pericardial space, increasing the predisposition to penetrate neighboring cardiac cavities, such as the RV. There are reports of suture failure associated with infective endocarditis but this hypothesis was ruled out in our case.…”

“…The devices used for similar interventions include coils, and various devices from the Amplatzer family. 1,7,8 Based on the literature review and our own experience, ADO II was the most suitable device. The device was perfectly fitted across the tunnel achieving complete shunt closure and patient clinical recovery.…”