Sood Nitin, Ehrlich Peter, Meerbach Dorothee, Kindermann Michael
Department of Cardiology and Angiology, CaritasKlinikum, Saarbruecken, Academic Teaching Hospital of the Saarland University Faculty of Medicine, Rheinstrasse 2, 66113 Saarbruecken, Germany.
Eur Heart J Case Rep. 2019 Dec 23;4(1):1-5. doi: 10.1093/ehjcr/ytz231. eCollection 2020 Feb.
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.
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.
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.
医源性主动脉-右心房瘘是心脏手术中一种罕见但具有临床相关性的并发症。经股动脉经皮封堵是手术修复的一种有吸引力的替代方法，但尚无关于使用完全上肢入路进行经导管修复的报道。
我们报告了一例44岁女性患者，因15年前二尖瓣置换术后长期存在的医源性瘘管，从无冠主动脉瓣叶至右心房（RA），伴有主动脉至RA分流以及严重三尖瓣反流（TR），导致心力衰竭（纽约心脏协会III级）。该患者通过使用完全肱动脉入路，采用Amplatzer血管封堵器II进行经皮封堵成功治疗。术后右心腔和TR减轻，症状缓解。
据我们所知，这是首次使用完全上肢入路（桡动脉和贵要静脉）经皮修复主动脉-右心房瘘的报道。在适当选择的患者中，这种方法是股动脉入路的一种有吸引力的替代方法。
