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Updated: Jan 30, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Heart failure due to aorto-right atrial fistula and successful treatment with percutaneous closure
Anar Mammadli1, Mustafa Kılıçkap, İrem Dinçer
1Department of Cardiology, Ankara University Faculty of Medicine, Ankara, Turkey. drmammadli@yahoo.com.
Insights
A rare aorto-right atrial fistula was successfully closed using a minimally invasive percutaneous device. This intervention significantly improved the patient's heart function and reduced symptoms like ascites.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Aorto-atrial fistula is a rare cardiac anomaly, often resulting from acquired conditions like endocarditis, dissection, or postsurgical complications.
- Patients may present with symptoms of heart failure, including dyspnea and ascites, leading to significant functional impairment.
Observation:
- A 50-year-old female with a history of cardiac surgery and heart failure presented with severe dyspnea and ascites (NYHA class III).
- Physical examination revealed a systolic murmur, ascites, and hepatomegaly.
- Diagnostic imaging, including echocardiography and aortography, confirmed an aorto-right atrial fistula.
Findings:
- Percutaneous closure of the aorto-right atrial fistula was performed using an Amplatzer Duct Occluder II device due to high surgical risk.
- The patient experienced a rapid and dramatic improvement in symptoms, with reduced ascites and diuretic requirements within one week.
- Functional capacity improved to NYHA class II, and right atrial pressure normalized within one month post-procedure.
Implications:
- Percutaneous closure offers a safe and effective alternative for managing aorto-atrial fistulas in high-risk patients.
- Minimally invasive techniques can lead to rapid symptom relief and functional recovery.
- Successful fistula closure can significantly improve outcomes for patients with complex cardiac conditions.
Abstract:
Aorto-atrial fistula is a rare anomaly of the heart that may be the result of congenital or acquired conditions, such as bacterial endocarditis, paravalvular abscess, aortic dissection, or a complication of cardiac surgery. A 50-year-old female patient presented at the clinic with the complaint of dyspnea and abdominal distention due to ascites. On admission, her functional capacity was New York Heart Association (NYHA) class III. A physical examination revealed a systolic murmur, which was best audible in the right parasternal side, ascites, and hepatomegaly. An aorto-right atrial fistula was detected using transthoracic echocardiography and confirmed with transesophageal echocardiography and aortography. The patient had a history of previous cardiac surgery, anticoagulant use, and heart failure; therefore, percutaneous intervention was preferred to surgery as a result of the high surgical risk. A successful closure of the fistula was performed with an Amplatzer Duct Occluder II device. The patient demonstrated a dramatic response to the treatment, resulting in a decrease in the ascites and halving of her diuretic dose within 1 week. Her functional capacity improved to NYHA class II, and right atrial pressure decreased to 8 mmHg after a month.
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