Department of Anesthesiology and Perioperative Medicine, Penn State Hershey Medical Center, Hershey, PA, USA.
Am J Case Rep. 2022 Jul 21;23:e936749. doi: 10.12659/AJCR.936749.
BACKGROUND Aorto-atrial fistulas (AAFs) are rare lesions typically associated with paravalvular abscesses or aortic aneurysms. Iatrogenic AAFs have been described after cardiac surgery. While these lesions are often asymptomatic, they can cause shunting and volume overload. Diagnosis of AAFs can be challenging. Transesophageal echocardiography plays a critical role in their diagnosis. CASE REPORT A 91-year-old man undergoing transcatheter aortic valve replacement (TAVR) for severe aortic stenosis had extreme tortuosity of the aorta and iliofemoral vessels. The patient developed a fistula from the non-sinus of Valsalva to the right atrium during the procedure. After the procedure, the patient developed stroke and retroperitoneal hematoma. CONCLUSIONS This case represents the first full report of an aorta to right atrial fistula after TAVR. The anatomy of the aortic root in relation to the right atrium and ventricle may make aorta to right ventricle fistulas more common than aorta to right atrial fistulas. This patient's vascular tortuosity may have played a role in the development of this lesion. Blood flow in an aorta to right atrial fistula occurs during both systole and diastole, making both right and left ventricle overload possible. Echocardiography is essential to the diagnosis of these lesions. Both vascular injury and landing zone rupture are possible during TAVR, although the observed timing and anatomy of this lesion suggest that it was caused during retrograde access of the left ventricular outflow tract via the ascending aorta.
主动脉-心房瘘（AAFs）是一种罕见的病变，通常与瓣周脓肿或主动脉瘤有关。医源性 AAFs 已在心脏手术后被描述。虽然这些病变通常无症状，但它们会导致分流和容量过载。AAF 的诊断具有挑战性。经食管超声心动图在其诊断中起着关键作用。
一名 91 岁男性因严重主动脉瓣狭窄而行经导管主动脉瓣置换术（TAVR），其主动脉和髂股血管极度迂曲。在手术过程中，患者从非窦 Valsalva 到右心房出现瘘管。手术后，患者发生中风和腹膜后血肿。
本例是 TAVR 后首例完全报告的主动脉-右心房瘘。主动脉根部与右心房和心室的解剖结构可能使主动脉-右心室瘘比主动脉-右心房瘘更常见。该患者的血管迂曲可能在该病变的发展中起作用。主动脉-右心房瘘中的血流在收缩期和舒张期都发生，这使得右心室和左心室都有可能过载。超声心动图对于这些病变的诊断至关重要。虽然观察到的病变时间和解剖结构提示它是在通过升主动脉逆行进入左心室流出道期间引起的，但在 TAVR 期间可能会发生血管损伤和着陆区破裂。
