Slim Ahmad M, Sanghi Pramod, Shry Eric A, Castillo-Rojas Laudino, Alvarez Jorge, Hernandez Antonio, Conner William C, Erikson John, Bailey Steven R
Cardiology Service, Brooke Army Medical Center, San Antonio, TX 78234-6200, USA.
J Interv Cardiol. 2008 Jun;21(3):260-4. doi: 10.1111/j.1540-8183.2007.00325.x. Epub 2007 Dec 11.
Clinically significant cardiac fistulas occur rarely and traditionally are surgically repaired. We describe the first known case of percutaneous closure of a left ventricular outflow tract (LVOT) to left atrium (LA) fistula formed as the result of aortic valve replacement surgery.
The patient was an 86-year-old woman with a history of aortic valve replacement who began complaining of shortness of breath 7 years later. Initially she was misdiagnosed as having mitral regurgitation. However, a transesophageal echocardiography (TEE) showed the presence of a 7.5 mm fistula between her LVOT and LA, producing a large regurgitant jet. As she was not a good surgical candidate, she underwent percutaneous closure. An Amplatzer Duct Occluder 9-PDA-006 (10 mm x 8 mm) device was successfully deployed in the fistula using TEE guidance. On follow-up, the patient described marked improvement of her symptoms.
In the rare case of cardiac fistulas that are deemed high risk for surgical intervention, a percutaneous approach with an occlusive device offers promise in treating these patients.
具有临床意义的心脏瘘管很少见，传统上通过手术修复。我们描述了首例已知的经皮闭合因主动脉瓣置换手术形成的左心室流出道（LVOT）至左心房（LA）瘘管的病例。
该患者是一名86岁女性，有主动脉瓣置换病史，7年后开始出现气短症状。最初她被误诊为二尖瓣反流。然而，经食管超声心动图（TEE）显示其LVOT与LA之间存在一个7.5毫米的瘘管，产生大量反流束。由于她不是手术的合适人选，她接受了经皮闭合治疗。在TEE引导下，一枚Amplatzer动脉导管封堵器9-PDA-006（10毫米×8毫米）成功植入瘘管。随访时，患者称症状明显改善。
在心脏瘘管被认为手术干预风险高的罕见情况下，使用封堵装置的经皮治疗方法为治疗这些患者带来了希望。
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