Aortic pseudoaneurysm with a fistula between the non-coronary sinus and right atrium: a case report

Submitted: April 28, 2024
Accepted: May 23, 2024
Published: August 29, 2024
Abstract Views: 81
PDF_EARLY VIEW: 46
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

The authors present a case report of a 68-year-old man evaluated at the emergency department for repeated syncope, asthenia, and general malaise, suggesting heart failure in a patient with several comorbidities. At presentation, the patient was afebrile, but he had reported a low-grade fever in the previous six months. At first glance, transthoracic echocardiography was not clear, while transesophageal echocardiography revealed an echo-free image at the level of the non-coronary sinus of the aortic root, suggestive of a pseudoaneurysm, communicating with the right atrium with continuous systo-diastolic flow, compatible with the aorto-cavitary fistula between the aortic root and the RA. Echocardiographic findings were confirmed by cardiac computed tomography. The case was discussed with the heart team and was considered suitable for surgery, but the patient suddenly died just before surgery due to impairment and friability.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Fierro EA, Sikachi RR, Agrawal A, et al. Aorto-Atrial fistulas: a contemporary review. Cardiol Rev 2018;26:137-44. DOI: https://doi.org/10.1097/CRD.0000000000000182
Gajjar T, Voleti C, Matta R, et al. Aorta‐right atrial tunnel: clinical presentation, diagnostic criteria, and surgical options. J Thorac Cardiovasc Surg 2005;130:1287‐92. DOI: https://doi.org/10.1016/j.jtcvs.2005.07.021
Onorato E, Casilli F, Mbala‐Mukendi M, et al. Sudden heart failure due to a ruptured posterior Valsalva sinus aneurysm into the right atrium: feasibility of catheter closure using the Amplatzer duct occluder. Ital Heart J 2005;6:603‐7.
Anguera I, Miro JM, Vilacosta I, et al. Aorto-cavitary fistulous tract formation in infective endocarditis: clinical and echocardiographic features of 76 cases and risk factors for mortality. Eur Heart J 2005;26:288-97. DOI: https://doi.org/10.1093/eurheartj/ehi034
Ananthasubramaniam K, Karthikeyan V. Aortic ring abscess and aorto atrial fistula complicating fulminant prosthetic valve endocarditis due to Proteus mirabilis. J Ultrasound Med 2000;19:63-6. DOI: https://doi.org/10.7863/jum.2000.19.1.63
Generali T, Garatti A, Biondi A, et al. Aorta to right atrial shunt due to the rupture of a degenerative aneurysm of the noncoronary sinus of Valsalva. J Cardiovasc Med 2013:71-3. DOI: https://doi.org/10.2459/JCM.0b013e3283528f8c
Campisi S, Cluzel A, Vola M, Fuzellier JF. Idiopathic aortic root to right atrial fistula. J Card Surg 2016;31:373-5. DOI: https://doi.org/10.1111/jocs.12751
Chessa M, De Rosa G, Giamberti A, et al. Congenital aortico-right atrial communication: a rare case in an adult patient. Int J Cardiol 2006;113:E105-6. DOI: https://doi.org/10.1016/j.ijcard.2006.05.037
Anguera I, Quaglio G, Miro JM, et al. Aorto cardiac fistulas complicating infective endocarditis. Am J Cardiol 2001;87:652-4. DOI: https://doi.org/10.1016/S0002-9149(00)01449-1
Rognoni A, Iorio S, Leverone M, Marino P. Aortic pseudoaneurysm and aorta‐right atrium fistula: a case report. G Ital Cardiol 2006;7:234‐7.
Bouchez S, Wouters PF, Vandenplas G. Asymptomatic aorto-atrial fistula identified with intraoperative transesophageal echocardiography. J Cardiothorac Vasc Anesth 2012;26:e76-7. DOI: https://doi.org/10.1053/j.jvca.2012.06.028
Martyn RT, Monaghan MJ, Michalis LK, Jewitt DE. Aortoatrial fistulae diagnosed by transthoracic and transesophageal echocardiography: advantages of the transesophageal approach. J Am Soc Echocardiogr 1993:6:21-9. DOI: https://doi.org/10.1016/S0894-7317(14)80252-6
Despotopoulos S, Apostolopoulou S, Vagenakis G, et al. Descending aorta to right atrial fistula: Transcatheter embolization of a very rare anomaly with coils. Clin Case Rep 2024;12:e8529. DOI: https://doi.org/10.1002/ccr3.8529
Attie F, Rosas M, Granados N, et al. Surgical treatment for secundum atrial septal defects in patients >40 years old. A randomized clinical trial. J Am Coll Cardiol 2001;38:2035-42. DOI: https://doi.org/10.1016/S0735-1097(01)01635-7
Fuse S, Tomita H, Hatakeyama K, et al. Effect of size of a secundum atrial septal defect on shunt volume. Am J Cardiol 2001;88:1447-50. DOI: https://doi.org/10.1016/S0002-9149(01)02134-8
Anguera I, Miro JM, San Roman JA, et al. Periannular complications in infective endocarditis involving prosthetic aortic valves. Am J Cardiol 2006;98:1261-8. DOI: https://doi.org/10.1016/j.amjcard.2006.05.066
Temple Jr. TE, Rainey RL, AnabtawiI N. Aortico-atrial shunt due to rupture of a dissecting aneurysm of the ascending aorta. J Thorac Cardiovasc Surg 1966;52:249-54. DOI: https://doi.org/10.1016/S0022-5223(19)43440-5
Hernandez-Garcia JM, Alonso-Briales JH, Jimenez-Navarro MF, et al. Transcatheter closure of aorto-left atrial fistula using an Amplatzer device. Rev Esp Cardiol 2005;58:1121-3. [Article in Spanish]. DOI: https://doi.org/10.1016/S1885-5857(06)60443-X
Foster TJ, Amin AH, Busu T, Patel K, et al. Aorto-cardiac fistula etiology, presentation, and management: a systematic review. Heart Lung 2020;49:317-23. DOI: https://doi.org/10.1016/j.hrtlng.2019.11.002

How to Cite

Toritto, Paolo, Elena Cescutti, Igor Vendramin, Michela Puppato, Massimo Imazio, Stefano De Carli, and Olga Vriz. 2024. “Aortic Pseudoaneurysm With a Fistula Between the Non-Coronary Sinus and Right Atrium: A Case Report”. Monaldi Archives for Chest Disease, August. https://doi.org/10.4081/monaldi.2024.3039.