Percutaneous Closure of an Iatrogenic Aorta to Right Ventricle Fistula Acquired Following Intracardiac Repair

Abstract

Iatrogenic aortocardiac fistulae have been described rarely following intracardiac repair. This 28 year-old-male presented to our facility with dyspnea going on 20 days after closure of ventricular septal defect (VSD) and resection of subaortic membrane. A communication was noticed between the aorta and the right ventricle (RV) upon transthoracic echocardiography. Cardiac catheterisation revealed a significant shunt and an aortogram revealed a 6 mm communication between aorta and right ventricle. Percutaneous closure of this defect was attempted under local anaesthesia through right femoral access. An alpha arteriovenous loop was formed despite repeated attempts, hence a retrograde approach for device delivery was considered. An 8 mm Amplatzer muscular VSD occluder device was deployed across the defect achieving a complete closure through an 8F delivery sheath. To the best of our knowledge this is the first report of an iatrogenic aorta to RV fistula occurring in a patient following an intracardiac repair which has been successfully treated percutaneously.

Keywords: Aorto-RV fistula; Aortocardiac fistula; Iatrogenic; Percutaneous intervention; Transcatheter closure.

Figure 1

Iatrogenic communication between aorta (right coronary sinus) and right ventricle on 2D echocardiography and on aortogram. (A) Fistula (arrow) between aorta and right ventricle seen in apical 5 chamber view. (B) Fistula (arrow) between aorta (right coronary sinus) and right ventricle seen in parasternal short axis view. (C) Fistula (arrow) between aorta and right ventricle seen in parasternal long axis view. (D) Aortgram in AP view demonstrating a 6 mm communication between aorta and right ventricle (arrow).

Figure 2

(A) Alpha arteriovenous loop (arrow) in view of which a retrograde approach was considered for device delivery. (B) Depicting 8 mm Amplatzer muscular ventricular septal defect (VSD) occluder device (arrow) positioned retrogradely across the aorto-right ventricular fistula seen in AP view. (C) Post procedure aortogram in AP view showing the Amplatzer muscular VSD occluder device (arrow) in position across the aorto-right ventricular fistula with no residual shunt. (D) Post procedure transthoracic echocardiography showing the Amplatzer muscular VSD occluder device in position across the aorto-right ventricular fistula with no residual shunt.