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. 2020 May-Jun;49(3):317-323.
doi: 10.1016/j.hrtlng.2019.11.002. Epub 2019 Nov 15.

Aorto-cardiac fistula etiology, presentation, and management: A systematic review

Tianne J Foster  1 , Ali Hama Amin  2 , Tatiana Busu  1 , Kinjan Patel  1 , Peter Farjo  1 , Abdulrahman Al Hallak  3 , Nyaz Ali  4 , Mohamad Alkhouli  5
Affiliations

Aorto-cardiac fistula etiology, presentation, and management: A systematic review

Tianne J Foster et al. Heart Lung. 2020 May-Jun.

Abstract

Background: Aorto-cardiac fistulae are a rare but increasingly reported entity, and data are scarce.

Method: The authors performed a systematic review of ACFs to characterize the underlying etiology, clinical presentation, and compare outcomes of treatment strategies.

Results: 3,733 publications were identified in the search. Of those, 292 studies including 300 patients were included. Etiology of ACFs was 38% iatrogenic, 25% infectious, 14% traumatic, and 15% due to other causes. Most patients (74%) presented with heart failure. Common locations were aortic-right atrium (37%), and aortic-pulmonary artery (25%). The majority of patients (71%) were treated surgically, while 13% were treated percutaneously, and 16% were treated conservatively. Patients who were managed conservatively had a higher mortality than those treated with invasive closure (53% vs. 12% vs. 3%, p = <0.00001).

Conclusions: This systematic review sheds light on this highly morbid condition. Once recognized, fistula closure appears to be superior to conservative management.

Keywords: Aortic valve replacement; Aorto-atrial fistula; Aorto-cardiac fistula; Aorto-cavitary fistula; Surgical fistula closure; Transcatheter intervention.

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Conflict of interest statement

Declaration of Competing Interest None

Figures

Fig. 1.
Fig. 1.
PRISMA search protocol.
Fig. 2.
Fig. 2.
Anatomy of the aorto-cardiac fistulae. RA, right atrium; LA, left atrium; AO, aorta; RV, right ventricle; LV, left ventricle; PA, pulmonary artery; AO-RA, aorto-right atrium fistula; AO-LA, aorto-left atrium fistula; AO-RV, aorto-right ventricle fistula; AO-LV, aorto-left ventricle fistula; AO-PA, aorto-pulmonary artery fistula.
Fig. 3.
Fig. 3.
Etiology of the aorto-cardiac fistulae. SOV, sinus of Valsalva.
Fig. 4.
Fig. 4.
Presentation of ACF patients within each management strategy.
Fig. 5.
Fig. 5.
Number of ACF cases reported within each management strategy.
See this image and copyright information in PMC

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