Key result
Percutaneous LVOT-to-LA fistula closure with an Amplatzer Duct Occluder successfully relieves severe symptoms.
Why the study?
Clinically significant cardiac fistulas are rare and traditionally repaired surgically, but less invasive percutaneous closure options need evaluation in high-risk surgical candidates.
Case Report (n=1)
Percutaneous LVOT-LA fistula closure may be feasible post-AVR; leaves open questions of safety and durability beyond this single case.
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. CASE REPORT: 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. DISCUSSION: 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.
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Slim et al. (2007) conducted a case report in Left ventricular outflow tract (LVOT) to left atrium (LA) fistula (n=1). Percutaneous closure using an Amplatzer Duct Occluder was evaluated on Symptom improvement and successful device deployment. Percutaneous closure of an LVOT to left atrium fistula using an Amplatzer Duct Occluder was successfully performed in an 86-year-old woman, resulting in marked symptom improvement.
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