Type A Aortic Dissection Complicated by an Aorto-Right Atrial Fistula

Abstract

A 63-year-old male underwent an ascending aortic replacement for an acute type A dissection. Nine days later a fistulous communication between the right coronary sinus and right atrium was identified and surgically repaired. We present a literature review, including the clinical presentation, diagnosis, and surgical management of this rare complication.

Eine seltene Ursache für akute Herzinsuffizienz?

“…Eine erworbene ARAF wurde erstmals 1961 beschrieben und tritt am häufigsten nach Trauma, einschließlich stumpfer Verletzungen, penetrierender Traumata und Operationen, wie Aortenklappenersatz, auf [ 4 , 5 ]. Andere Ursachen sind unter anderem infektiöse Endokarditis und Aortendissektion [ 6 , 7 ]. Eine weitere sehr viel seltenere Ursache für diese Art von Fistel ist eine Ruptur eines Aneurysmas oder Pseudoaneurysmas des Sinus Valsalva [ 8 ].…”

Transcatheter closure of an aortoatrial fistula following a surgical aortic valve replacement

“…Aorto-atrial fistulas (AAF) are rare but serious complications of infective endocarditis, aortic or mitral valve replacement, transseptal catheterization, connective tissue disease, and aortic dissection. [1][2][3][4] AAF may present as an asymptomatic incidental finding on an imaging study or result in florid congestive heart failure. Although the natural history of AAF after aortic valve surgery is not well studied, spontaneous closure has not been reported.…”

Commentary: The enemy of good is perfect, but please define good and perfect

“…It addresses a complicated version of an already-complicated, high-risk, urgent operation with a combination of novelty and simplicity that allows the young patient a valve-sparing approach with resolution of the fistula and an overall positive outcome. 2 Or is it that simple?…”