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Case Reports
. 2024 Feb 13;12(2):e8529.
doi: 10.1002/ccr3.8529. eCollection 2024 Feb.

Descending aorta to right atrial fistula: Transcatheter embolization of a very rare anomaly with coils

Stefanos Despotopoulos  1 , Sotiria Apostolopoulou  1 , George Vagenakis  1 , Meletios Kanakis  2 , George Samanidis  3 , Panagiotis Zachos  4 , Anastasios Chatziantoniou  1 , John Papagiannis  1 , Spyridon Rammos  1 , Alexandros Tsoutsinos  1
Affiliations
Case Reports

Descending aorta to right atrial fistula: Transcatheter embolization of a very rare anomaly with coils

Stefanos Despotopoulos et al. Clin Case Rep. .

Abstract

Key clinical message: Descending aorta to right atrial (RA) fistula is a rare and distinct clinical entity mimicking patent ductus arteriosus (PDA) and it may lead to rapid development of pulmonary vascular disease. Correct diagnosis and treatment, especially in the presence of other congenital heart defects, is very important. Interventional management is the treatment of choice.

Abstract: We present a case report of a trisomy 21 infant with atrial and ventricular septal defects and small patent ductus arteriosus (PDA) complicated by the presence of descending aorta to right atrial (RA) fistula with large left to right shunt leading to rapid increase in pulmonary vascular resistance. Transcatheter occlusion of the fistula followed by closure of the PDA with Nit-Occlud coil systems led to decreased pulmonary pressure and resistance permitting successful surgical repair of the patient's intracardiac defects with good outcome over 3 years of follow-up. Descending aorta to RA fistula is a rare and distinct clinical entity mimicking PDA and its correct diagnosis and treatment, especially in the presence of other congenital heart defects, is very important as it may lead to rapid development of pulmonary vascular disease.

Keywords: aorta to right atrial fistula; cardiac surgery; coil; congenital heart disease; transcatheter occlusion.

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Figures

FIGURE 1
FIGURE 1
Frontal (A) and lateral (B) projection of descending aortogram depicting a very tortuous vessel with many stenotic and dilated portions originating just below the isthmus and entering the right atrium (arrow).
FIGURE 2
FIGURE 2
(A) Lateral projection of descending aortogram 4 months after the fistula closure showing complete occlusion of the fistula by the Nit‐Occlud coil system with very narrow tract (arrow) from the ampulla of the fistula to the coil. The arrowhead points to the patent dusctus arteriosus. (B) Lateral projection of descending aortogram after the patent ductus arteriosus closure depicts the Nit‐Occlud coil system in the occluded fistula with the narrow tract leading to it and placed Nit‐Occlud coil system above it occluding the patent ductus arteriosus.
FIGURE 3
FIGURE 3
Pulmonary artery waveform before and after intervention depicting a significant drop in the pressure.
See this image and copyright information in PMC

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