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Incidental Finding of an Aorto-Right Atrial Fistula in a Patient Undergoing Repair of a Sinus of Valsalva Aneurysm.

ABSTRACT: A sinus of Valsalva aneurysm is a rare malformation of the aortic root that can fistulize to another cardiac structure such as the right atrium. Although transthoracic echocardiography and computed tomography angiography have demonstrated utility for the diagnosis of a sinus of Valsalva-to-right atrial fistula, there are few cases where a misdiagnosis may occur. Intraoperative transesophageal echocardiography may be an essential imaging tool for the diagnosis and management of incidental findings such as a sinus of Valsalva-to-right atrial fistula during cardiac surgery and should be used routinely.

SUBMITTER: Rosero-Britton BR

PROVIDER: S-EPMC5492701 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Incidental Finding of an Aorto-Right Atrial Fistula in a Patient Undergoing Repair of a Sinus of Valsalva Aneurysm.

Rosero-Britton Byron R BR Nguyen Anthony A Warsame Ibrahim I Shabsigh Muhammad M Dong Luke L Wolfe James J Whitson Bryan B Essandoh Michael M

Frontiers in medicine 20170630

A sinus of Valsalva aneurysm is a rare malformation of the aortic root that can fistulize to another cardiac structure such as the right atrium. Although transthoracic echocardiography and computed tomography angiography have demonstrated utility for the diagnosis of a sinus of Valsalva-to-right atrial fistula, there are few cases where a misdiagnosis may occur. Intraoperative transesophageal echocardiography may be an essential imaging tool for the diagnosis and management of incidental finding ...[more]

PMID: 28713813

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Percutaneous closure of an iatrogenic aorto-right atrial fistula of the sinus of Valsalva through total arm approach: a case report.

Project description:Background?:Creation of an iatrogenic aorto-right atrial fistula is a rare but clinically relevant complication of cardiac surgery. Transfemoral percutaneous closure is an attractive alternative to surgical repair, but there are no reports about transcatheter repair using a complete arm access. Case summary?:We present the case of a 44-year-old woman with heart failure (NewYork Heart Association Class III) due to a longstanding iatrogenic fistula from the non-coronary aortic cusp to the right atrium (RA) with aorta to RA shunting and severe tricuspid regurgitation (TR) caused by mitral valve replacement 15?years ago. The patient was successfully treated by percutaneous closure with an Amplatzer Vascular Plug II using complete brachial access. Following the procedure right heart chambers and TR decreased and symptoms resolved. Discussion?:To the best of our knowledge this is the first report of percutaneous repair of an aorto-right atrial fistula using total arm accesses (radial artery and basilic vein). In appropriately selected patients, this approach is an attractive alternative to femoral access.

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A rare variant of a ruptured sinus of valsalva aneurysm forming an aorto-atrial fistula: a case report and review of literature

Project description:Abstract Background Sinus of valsalva aneurysms (SOVAs) are infrequent findings and generally diagnosed incidentally. A SOVA may be at risk for rupture, which would lead to an aorto-cardiac shunt. These patients present similarly to decompensated heart failure. Case Presentation We present a case of a 44-year-old female with a ruptured non-coronary SOVA diagnosed by echocardiogram during evaluation for exertional dyspnoea. A trans-oesophageal echocardiogram (TEE) revealed a 2.1 cm non-coronary SOVA with windsock communication to the right atrium. The patient refused surgery, and two years later, presented with florid right heart failure with preserved left ventricular function. The right ventricle was severely dilated and hypokinetic with right atrial enlargement. After finally agreeing to surgery, a pre-operative catheterization revealed non-obstructive coronaries and a significant left to right shunt with elevated pulmonary pressure. The patient had suboptimal response to diuretic therapy and was sent for successful repair of the aneurysm with the closure of the aorto-atrial fistula via bovine pericardial patch and resolution of the left to right shunt as demonstrated by intra-operative TEE. Her right-sided heart failure symptoms subsequently resolved. Discussion SOVA is a rare finding but should still be considered in the differential in young and middle-aged patients with symptoms of acute heart failure, hemodynamic compromise, and a new continuous heart murmur. Early surgical repair is highly recommended to prevent acute and long-term complications.

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Right Valsalva Sinus Aneurysm Protruding Into the Right Ventricle: A Case Report.

Project description:A separation between the aortic media and annulus fibrosus causes a rare cardiac abnormality called sinus of Valsalva aneurysm (SVA) that may be congenital or acquired. It is more prevalent in the right coronary sinus (65%-85%) but it has been seen rarely in non-coronary (10%-30%) or Left coronary sinus (<5%). The most common complication is rupture of the Aneurysm. We present an 80-year-old male with expanding right Valsalva sinus aneurysm and protruding into right ventricle. The conventional treatment is surgical repair under cardio-pulmonary bypass or percutaneous catheter closure. The aneurysm was successfully excised surgically under direct guidance of trans-esophageal echocardiography (TEE).

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Rapid growth of right sinus Valsalva aneurysm dissecting into interventricular septum.

Project description: Not available

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[A rare cause of acute heart failure? : Aorto-right atrial fistula!]

Project description:BackgroundAcute heart failure with symptoms such as dyspnea and edema has various causes. In rare cases cardiac fistulas can cause acute heart failure. Herein we present a case of subacute heart failure due to an acquired fistula between the aorta and right atrium.Case reportA 48-year-old male was referred to the emergency room with increasing dyspnea on exercise and pitting edema of the lower extremities starting approximately 4 weeks previously. Echocardiographic workup showed an aorta-to-right atrium fistula. The patient was referred to a cardiothoracic surgery center for closure of the fistula.

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Giant sinus of Valsalva aneurysm-a peculiar presentation with atrial fibrillation.

Project description: Not available

| S-EPMC7885990 | biostudies-literature

Acute type A aortic dissection complicated with an aorto-right atrial fistula.

Project description: Not available

| S-EPMC8288752 | biostudies-literature

Coronary artery aneurysm with a fistulous connection to the right atrium mimicking a sinus of Valsalva aneurysm.

Project description:Coronary artery aneurysms are uncommon and may be complicated by rupture, thromboembolic phenomenon, and more rarely fistulation into one of the cardiac chambers. This case report highlights the difficulty in making a preoperative diagnosis of a coronary artery aneurysm that has fistulated into the right atrium, and lists possible differential diagnoses.

| S-EPMC1767494 | biostudies-literature

Percutaneous Transcatheter Closure of Iatrogenic Aorto-right Atrial Fistula Using the Amplatzer Duct Occluder.

Project description: Not available

| S-EPMC8424451 | biostudies-literature

Unusual double-chambered right ventricle induced by ruptured sinus of Valsalva aneurysm: A case report.

Project description:A 54-year-old male with a history of unrepaired ventricular septal defect (VSD) suffered from easy fatigability on exertion. A Levine grade V/VI continuous murmur was auscultated. Transthoracic echocardiogram showed a ruptured sinus of Valsalva aneurysm (SVA) and a significant left-to-right shunting from the ascending aorta to the right ventricle (RV). In addition, a 36 mmHg of pressure gradient was observed between the inflow and outflow tract in the RV, suggesting double-chambered RV (DCRV). Cardiac catheterization also revealed 33 mmHg of the pressure gradient in the mid-potion of the RV, which was coincident with DCRV. A calculated pulmonary-to-systemic flow ratio was 3.0. Therefore, the patient was offered surgical repair of the ruptured SVA and VSD, which was successfully performed. During the surgery, an anomalous muscle band, which is usually the cause of DCRV, was not found, instead, a thickened RV free-wall due to the exposure of the left-to-right shunt flow, so-named jet lesion, was found. Therefore, surgical resection of the anomalous muscle band was not required. The protruded SVA toward the RV, the jet lesion, and the increased RV stroke volume, which could induce relative stenosis, were the causes of the unusual DCRV. <Learning objective: A mechanism of an unusual double-chambered right ventricle induced by ruptured sinus of Valsalva aneurysm (SVA) is as follows. One is a morphological stenosis in the right ventricle (RV) due to a protruded SVA toward the RV. The second is a jet lesion; a thickened RV wall induced by the exposure of the shunt flow from the ascending aorta. The third is a relative stenosis due to the increased stroke volume of the RV.>.

| S-EPMC7588484 | biostudies-literature

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