Charif Fida, Nassar Pierre, Youssef Dani, Neghawi Ziad, Saab Mohamad
Pulmonary Critical Care Medicine, Beirut Cardiac Institute, Beirut, LBN.
Adult Cardiology Division, Beirut Cardiac Institute, Beirut, LBN.
Cureus. 2021 Apr 12;13(4):e14430. doi: 10.7759/cureus.14430.
Aorto-caval fistula (ACF) is a rare cause of high output heart failure (HOHF). 80 % of cases are due to ruptured abdominal aortic aneurysm, while 10 to 20% are traumatic or congenital. Early diagnosis and treatment are crucial in order to prevent the progression to HOHF. Open surgical repair has been the mainstay therapy of arterio-venous fistulas including aorto-caval fistula; however endovascular approach has become an evolving therapeutic option in the last 20 years. Here, we present a case of high output heart failure secondary to traumatic aorto-caval fistula due to shrapnel injury to the abdomen. Our patient was managed with endovascular approach by the deployment of amplatzer septal occluder that excluded completely the fistula, resulting in the progressive improvement of HOHF. In this manuscript, we review etiologies of high output heart failure and summarize cases of aorto-caval fistula treated with amplatzer septal occluder reported in literature. We also highlight the importance of this endovascular device in the presence of metallic foreign body in the aorta.
主动脉腔静脉瘘（ACF）是高输出量心力衰竭（HOHF）的一种罕见病因。80%的病例是由腹主动脉瘤破裂所致，而10%至20%是创伤性或先天性的。早期诊断和治疗对于预防进展为高输出量心力衰竭至关重要。开放手术修复一直是包括主动脉腔静脉瘘在内的动静脉瘘的主要治疗方法；然而，在过去20年中，血管内治疗方法已成为一种不断发展的治疗选择。在此，我们报告一例因腹部弹片伤导致创伤性主动脉腔静脉瘘继发高输出量心力衰竭的病例。我们的患者采用血管内治疗方法，通过植入Amplatzer房间隔封堵器完全封堵瘘口，使高输出量心力衰竭逐渐改善。在本手稿中，我们回顾了高输出量心力衰竭的病因，并总结了文献中报道的用Amplatzer房间隔封堵器治疗主动脉腔静脉瘘的病例。我们还强调了在主动脉存在金属异物的情况下这种血管内装置的重要性。
