Interventional closure of two fistulas after aortic valve surgery.
BACKGROUND
Paravalvular fistulas may complicate the clinical course after heart valve surgery. Medical treatment may be ineffective, repeated surgical revisions may be associated with increased morbidity and mortality.


METHODS
After valve sparing surgery in bicuspid aortic valve, a significant aorto-left atrial fistula was diagnosed in a 72-year-old patient causing heart failure and catecholamine-dependency. Due to the critical hemodynamic state, percutaneous closure was performed with an AGA Amplatzer duct occluder. Secondary to this closure, a second fistula between the aortic root and the right atrium appeared which was closed during the same procedure implanting a second duct occluder beneath the first device.


CONCLUSIONS
Percutaneous closure of paravalvular fistulas is feasible and a safe method for the treatment of significant shunts after valve surgery. Even in multiple fistulas, the implantation of small devices allows for a focussed interventional closure of such leaks. This procedure should be considered for such defects as it represents a safe method for the causative treatment in paravalvular lesions after valve surgery especially in patients with critical hemodynamic conditions.
Dalla Pozza
Robert
R
Department of Pediatric Cardiology, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany. Robert.DallaPozza@med.uni-muenchen.de
Kozlik-Feldmann
R
R
Le
T-P
TP
Schmitz
C
C
Sodian
R
R
Reichart
B
B
Netz
Heinrich
H
D000368:Aged; D001018:Aortic Diseases / Q000628:therapy*; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000601:surgery*; D021721:Balloon Occlusion / Q000379:methods; D002395:Catecholamines / Q000097:blood; D005260:Female; D006325:Heart Atria; D006331:Heart Diseases / Q000628:therapy*; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D011183:Postoperative Complications / Q000628:therapy*; D016896:Treatment Outcome; D016157:Vascular Fistula / Q000628:therapy*; D018487:Ventricular Dysfunction, Left / Q000601:surgery
D002395:Catecholamines