Fierro Elizabeth A, Sikachi Rutuja R, Agrawal Abhinav, Verma Isha, Ojrzanowski Marcin, Sahni Sonu
Cardiol Rev. 2018 May/Jun;26(3):137-144. doi: 10.1097/CRD.0000000000000182.
Aorto-atrial fistulas (AAFs) are a relatively rare, but potentially life-threatening condition, where an anomalous connection forms between the aortic structures and the cardiac atria. AAFs are most often the result of an underlying condition concerning the cardiac structures. It may be congenital, secondary to conditions such as aortic dissection, infective endocarditis, or valve replacement, or iatrogenic in nature. Secondary causes incite local deterioration of cardiac wall integrity leading to formation of fistulous connections, whereas iatrogenic causes are more traumatic in nature. Signs and symptoms include those of volume overload and heart failure, with patients often presenting with fever, regurgitative murmurs, cardiac chamber dilation, and pedal edema. The diagnosis of AAFs requires a high degree of clinical suspicion necessitating imaging techniques such as echocardiography, computer tomography, and more invasive procedures. Management is dependent on underlying conditions and include the use of antibiotics, percutaneous closure, and in many cases, open heart surgery. It is important for physicians to be aware of this pathological condition to aid in timely management and favorable outcomes. This review attempts to summarize the various causes and clinical presentations of AAFs over the past decades.
主动脉-心房瘘（AAFs）是一种相对罕见但可能危及生命的疾病，其特征是在主动脉结构与心脏心房之间形成异常连接。AAFs最常见的原因是与心脏结构相关的潜在疾病。它可能是先天性的，继发于诸如主动脉夹层、感染性心内膜炎或瓣膜置换等疾病，或者本质上是医源性的。继发性病因会引发心脏壁完整性的局部恶化，导致瘘管连接的形成，而医源性病因在本质上更具创伤性。体征和症状包括容量负荷过重和心力衰竭的表现，患者常出现发热、反流性杂音、心腔扩大和足部水肿。AAFs的诊断需要高度的临床怀疑，这就需要借助诸如超声心动图、计算机断层扫描等成像技术以及更多侵入性检查。治疗取决于潜在病因，包括使用抗生素、经皮封堵，在许多情况下还需要进行心脏直视手术。医生了解这种病理状况对于及时治疗并取得良好疗效很重要。本综述试图总结过去几十年中AAFs的各种病因和临床表现。
