Mammadli Anar, Kılıçkap Mustafa, Dinçer İrem, Akbulut İrem Müge, Sayın Tamer
Department of Cardiology, Ankara University Faculty of Medicine, Ankara, Turkey.
Turk Kardiyol Dern Ars. 2019 Jan;47(1):60-62. doi: 10.5543/tkda.2018.88399.
Aorto-atrial fistula is a rare anomaly of the heart that may be the result of congenital or acquired conditions, such as bacterial endocarditis, paravalvular abscess, aortic dissection, or a complication of cardiac surgery. A 50-year-old female patient presented at the clinic with the complaint of dyspnea and abdominal distention due to ascites. On admission, her functional capacity was New York Heart Association (NYHA) class III. A physical examination revealed a systolic murmur, which was best audible in the right parasternal side, ascites, and hepatomegaly. An aorto-right atrial fistula was detected using transthoracic echocardiography and confirmed with transesophageal echocardiography and aortography. The patient had a history of previous cardiac surgery, anticoagulant use, and heart failure; therefore, percutaneous intervention was preferred to surgery as a result of the high surgical risk. A successful closure of the fistula was performed with an Amplatzer Duct Occluder II device. The patient demonstrated a dramatic response to the treatment, resulting in a decrease in the ascites and halving of her diuretic dose within 1 week. Her functional capacity improved to NYHA class II, and right atrial pressure decreased to 8 mmHg after a month.
主动脉-心房瘘是一种罕见的心脏异常，可能由先天性或后天性疾病引起，如细菌性心内膜炎、瓣周脓肿、主动脉夹层或心脏手术并发症。一名50岁女性患者因腹水导致呼吸困难和腹胀前来就诊。入院时，她的功能状态为纽约心脏协会（NYHA）Ⅲ级。体格检查发现收缩期杂音，在右胸骨旁最易听到，有腹水和肝肿大。经胸超声心动图检测到主动脉-右心房瘘，并经食管超声心动图和主动脉造影证实。该患者有心脏手术史、抗凝药物使用史和心力衰竭史；因此，由于手术风险高，首选经皮介入而非手术治疗。使用Amplatzer II型动脉导管封堵器成功闭合了瘘管。患者对治疗反应显著，1周内腹水减少，利尿剂剂量减半。1个月后，她的功能状态改善至NYHAⅡ级，右心房压力降至8 mmHg。
