title: Surgical treatment of an aorto-right atrial fistula as a complication of tricuspid valve repair.
abstract: We report a case in which implantation of a rigid tricuspid annuloplasty ring resulted in an aorto-atrial fistula. In addition the patient had a series of complications which had occurred in the perioperative management of the initial operation, characterized by reoperation for mitral and tricuspidal ring dehiscence, and two reopenings for bleeding as well as postoperative sepsis. The attempt to close the fistula on the arrested heart failed. On presentation to our hospital the patient was in decompensated heart failure (NYHA class IV, ascites and pulmonary edema). Our surgical approach (fifth resternotomy) consisted of mitral valve replacement under cardioplegic arrest and re-tricuspid valve repair and closure of the AV fistula on the beating heart. Postoperatively, the patient was extubated on postoperative day one and discharged on postoperative day 41 in NYHA class II.
  
  
  CONCLUSIONS
  Performing a right heart procedure on the beating heart allowed proper identification of the fistula and easy closure.
authors.affiliation: Department of Cardiac Anesthesiology, University of Leipzig Heart Center, Leipzig, Germany.
authors.forename: P R
authors.initials: PR
authors.lastname: Menon
authors.forename: T
authors.initials: T
authors.lastname: Doenst
authors.forename: J
authors.initials: J
authors.lastname: Ender
authors.forename: F W
authors.initials: FW
authors.lastname: Mohr
authors.forename: D
authors.initials: D
authors.lastname: Mathioudakis
mesh_terms: D000368:Aged; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D058385:Cardiac Valve Annuloplasty / Q000009:adverse effects* / Q000295:instrumentation; D002315:Cardiopulmonary Bypass; D020878:Device Removal; D017548:Echocardiography, Transesophageal; D005260:Female; D006324:Heart Arrest, Induced; D006325:Heart Atria / Q000601:surgery; D006331:Heart Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D007049:Iatrogenic Disease; D008943:Mitral Valve / Q000601:surgery; D011474:Prosthesis Design; D012086:Reoperation; D056346:Sternotomy; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D016157:Vascular Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*