Department of Cardiology, Hospital de São João, Porto, Portugal.
Catheter Cardiovasc Interv. 2012 Feb 15;79(3):448-52. doi: 10.1002/ccd.23222. Epub 2011 Dec 12.
Aortocardiac fistulas are rare, especially if they develop after an aortic valve replacement surgery. We report the case of a 54-year-old male submitted to aortic valve replacement and implantation of an ascending aortic prosthetic graft, complaining of exertional dyspnea, who was found to have significant shunt between the aortic root and right ventricle (RV), and de novo moderate pulmonary hypertension. At the catheterization laboratory, the left-to-right shunt was confirmed (Qp:Qs = 1.9:1). Contrast angiography of the ascending aorta showed a significant flow into the right ventricular cavity, and the fistulous tract was then measured, inflating a Tyshak II balloon of 10 × 20 mm (NuMED, Hopkinton, New York), until achieving a complete interruption of flow. Minimal diameter of the defect was 4.9 mm. Percutaneous closure of the aorto-RV shunt was performed under general anesthesia and transesophageal echocardiogram and fluoroscopic guidance. Using a venous and an arterial femoral access, a 0.035″ hydrophilic guide-wire crossed the defect between the aorta and RV, creating an arteriovenous loop. Then, using a 7F Delivery System 45° (AGA medical corporation, Golden Valley, MN) an Amplatzer Duct Occluder(®) (AGA Medical Corporation) 8/6 mm was advanced and released within the defect, achieving an almost complete closure of the fistulous tract.
升主动脉-右心室瘘非常罕见，特别是在主动脉瓣置换手术后发生。我们报告了 1 例 54 岁男性，因主动脉瓣置换术和升主动脉人工移植物植入术后出现劳力性呼吸困难而就诊。该患者发现升主动脉根部和右心室之间存在显著分流，且新发中度肺动脉高压。在导管室，证实存在左向右分流（Qp:Qs=1.9:1）。升主动脉造影显示有大量血流进入右心室腔，然后测量瘘管，并使用 10×20mm 的 Tyshak II 球囊（NuMED，纽约州霍普金顿）进行充气，直到完全阻断血流。缺损最小直径为 4.9mm。在全身麻醉和经食管超声心动图及透视引导下，行经皮升主动脉-右心室分流封堵术。经股静脉和股动脉入路，0.035 英寸亲水导丝穿过主动脉和右心室之间的缺损，形成动静脉环。然后，使用 7F Delivery System 45°（AGA Medical Corporation，明尼苏达州 Golden Valley）将 8/6mm 的 Amplatzer Duct Occluder(®)（AGA Medical Corporation）推进并释放到缺损处，瘘管几乎完全闭合。
