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      An Unusual Case of Aortic-Right Atrium Fistula: A Diagnostic and Therapeutic Challenge

      case-report

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          Abstract

          An aorta-to-right atrium (RA) fistula is an anomalous communication between the ascending or descending thoracic aorta and the RA. In this report, we describe a case of an idiopathic aortic root-to-RA fistula occasionally found during a coronary angiography performed in a young patient admitted for acute chest pain with evidence of multivessel coronary artery disease. The anatomical peculiarity of this fistulous communication is that it gave origin to collateral vessels furnishing the inferolateral wall of the left ventricle. The case represented a diagnostic and therapeutic challenge that required a multimodality imaging and a multidisciplinary team approach.

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          Aorta-right atrial tunnel: clinical presentation, diagnostic criteria, and surgical options.

          R Matta, Saroj Dash, Vishwanath R. Iyer … (2005)
          Aorta-right atrial tunnel is a rare and distinct congenital anomaly. To the spectrum of aorta-right atrial communications, we want to add this separate entity of aorta-right atrial tunnel by presenting the clinical features, morphologic aspects, diagnostic criteria, surgical techniques, and outcome in various clinical settings for better understanding of this developmentally intriguing, clinically complex, and therapeutically challenging disorder. From June 1994 through October 2004, 9 patients were treated for aorta-right atrial tunnel at our institution. Ages ranged from 9 to 45 years. There were 5 male subjects and 4 female subjects. Morphologically, 2 types of tunnels were identified in relationship to the ascending aorta: the anterior type in 3 patients and the posterior type in 6 patients. In all patients the diagnosis was established by means of 2-dimensional echocardiography and transesophageal echocardiography and confirmed by means of angiography. Eight patients were treated surgically, and 1 patient was treated with coil embolization. Postoperative echocardiograms obtained for all patients before discharge confirmed complete obliteration of the tunnel. One patient died perioperatively, and the other 8 patients were discharged in stable condition. During follow-up at 3 months, 6 months, and 1 year, all patients were in New York Heart Association class I, and echocardiography showed no residual shunts. In patients with aorta-right atrial tunnel, 2-dimensional echocardiography and transesophageal echocardiography are enough to establish clinical diagnosis, but ascending aortography is necessary to differentiate from more common clinical conditions, like ruptured sinus of Valsalva aneurysm and coronary cameral fistula. The rarity of this condition is established by the fact that during the same period of time, we have treated in our institution 66 cases of ruptured sinus of Valsalva aneurysm, which is the most common aorta-right atrial communication. Treatment options are simple ligation or ligation with implantation of coronary ostium or coil embolization. The location of the coronary ostium dictates technical details. Follow-up reveals excellent functional recovery.
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            Aorta--right atrial communication. Report of an unusual case.

            M Such, Celia Coto, J M Caffarena … (1980)
            An unusual aneurysmal aorta--right atrial communication was found in a 25-year-old man with a rounded mass in the right cardiophrenic angle. Differential diagnoses included ruptured aneurysm of the sinus of Valsalva, coronary arteriovenous fistula, rupture of a dissecting aneurysm of the ascending aorta into the right atrium, and pseudoaneurysm of the right coronary artery followed by formation of a fistula between the aneurysm and the right atrium. Closure of the communication was performed under cardiopulmonary bypass. Complete absence of the right superior vena cava with a large persistent left superior vena cava draining to the coronary sinus was an unexpected finding at operation. The origin of the communication is not known; possible anomalous coronary and noncoronary origins are considered.
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              Aorta-right atrial tunnel.

              O Bayezid, Savas Tepe, A Belgi … (2003)
              Aorta-right atrial tunnel is rare. We report a case of aorta-right atrial tunnel in which the right coronary artery arose from the tunnel. Successful surgical treatment was performed.
              Article 0 comments Cited 9 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Cardiovasc Echogr
                Journal ID (iso-abbrev): J Cardiovasc Echogr
                Journal ID (publisher-id): JCE
                Title: Journal of Cardiovascular Echography
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 2211-4122
                ISSN (Electronic): 2347-193X
                Publication date (Print): Oct-Dec 2017
                Volume: 27
                Issue: 4
                Pages: 156-158
                Affiliations
                [1 ]Department of Clinical-Experimental Medicine and Pharmacology, Division of Cardiology, University of Messina, Messina, Italy
                [2 ]Cardiology Department, Ospedale Civile di Ivrea, Ivrea, Italy
                Author notes
                Address for correspondence: Dr. Maria Chiara Todaro, Via Consolare Valeria 1, Policlinico Universitario G. Martino, 98100 Messina, Italy. E-mail: kiaratodaro@ 123456yahoo.it
                Article
                Publisher ID: JCE-27-156
                DOI: 10.4103/jcecho.jcecho_36_17
                PMC ID: 5672691
                SO-VID: 5a883887-9872-4257-8b49-e142f8b16bac
                Copyright © Copyright: © 2017 Journal of Cardiovascular Echography
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                Categories
                Subject: Case Report

                Keywords: aorta-right atrium fistula,coronary artery disease,multimodality imaging
                Data availability:
                Keywords: aorta-right atrium fistula, coronary artery disease, multimodality imaging

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