Transcatheter cardiac fistula repair with the Amplatzer Duct Occluder: a case report and review.
BACKGROUND
Clinically significant cardiac fistulas occur rarely and traditionally are surgically repaired. We describe the first known case of percutaneous closure of a left ventricular outflow tract (LVOT) to left atrium (LA) fistula formed as the result of aortic valve replacement surgery.


METHODS
The patient was an 86-year-old woman with a history of aortic valve replacement who began complaining of shortness of breath 7 years later. Initially she was misdiagnosed as having mitral regurgitation. However, a transesophageal echocardiography (TEE) showed the presence of a 7.5 mm fistula between her LVOT and LA, producing a large regurgitant jet. As she was not a good surgical candidate, she underwent percutaneous closure. An Amplatzer Duct Occluder 9-PDA-006 (10 mm x 8 mm) device was successfully deployed in the fistula using TEE guidance. On follow-up, the patient described marked improvement of her symptoms.


CONCLUSIONS
In the rare case of cardiac fistulas that are deemed high risk for surgical intervention, a percutaneous approach with an occlusive device offers promise in treating these patients.
Slim
Ahmad M
AM
Cardiology Service, Brooke Army Medical Center, San Antonio, TX 78234-6200, USA. Ahmad.Slim@us.army.mil
Sanghi
Pramod
P
Shry
Eric A
EA
Castillo-Rojas
Laudino
L
Alvarez
Jorge
J
Hernandez
Antonio
A
Conner
William C
WC
Erikson
John
J
Bailey
Steven R
SR
D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000295:instrumentation; D017548:Echocardiography, Transesophageal; D005260:Female; D005402:Fistula / Q000175:diagnosis / Q000601:surgery*; D006325:Heart Atria / Q000601:surgery*; D006331:Heart Diseases / Q000175:diagnosis / Q000601:surgery*; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D019919:Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*