Transcatheter closure of tortuous aorto-right atrial fistula

Congenital fistula between the aorta and right atrium is a rare congenital anomaly of the heart. We report a new case of this unusual communication, which was successfully closed by transcatheter embolisation using an Amplatzer duct occluder II. A 7-year-old asymptomatic girl was referred to our institute for evaluation of a murmur. Echocardiography revealed intact septae and the right coronary sinus was dilated with a fistulous tract arising from the sinus and opening into the right atrium with continuous flow into the right atrium. Computerized tomography confirmed the diagnosis and delineated the anatomy. Cardiac catheterization performed confirmed the presence of a markedly tortuous and dilated aorto-right atrial fistula. Coronary angiography demonstrated normal coronary arteries arising from the respective sinuses. The fistula was closed antegradely using an Amplatzer duct occluder II (AGA Medical Corporation, Plymouth, MN, USA). The continuous murmur had disappeared after the procedure and an echocardiogram revealed no continuous flow across the fistulous tract. The patient remained well at follow-up 3 months later.