title: Transcatheter cardiac fistula repair with the Amplatzer Duct Occluder: a case report and review.
abstract: 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.
authors: Cardiology Service, Brooke Army Medical Center, San Antonio, TX 78234-6200, USA. Ahmad.Slim@us.army.mil
authors: Ahmad M
authors: AM
authors: Slim
authors: Pramod
authors: P
authors: Sanghi
authors: Eric A
authors: EA
authors: Shry
authors: Laudino
authors: L
authors: Castillo-Rojas
authors: Jorge
authors: J
authors: Alvarez
authors: Antonio
authors: A
authors: Hernandez
authors: William C
authors: WC
authors: Conner
authors: John
authors: J
authors: Erikson
authors: Steven R
authors: SR
authors: Bailey
mesh_terms: 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*