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Balloon closure of a surgical aorto-atrial communication
R Hayward1, B Kendall, T Treasure
1Department of Cardiology, Middlesex Hospital, London.
Insights
Persistent hemorrhage after aortic dissection repair was managed with a novel technique, creating an aorto-atrial shunt. Percutaneous closure of this shunt resolved low output syndrome, demonstrating an effective treatment for complex aortic surgical complications.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Medical Device Technology
Background:
- Surgical repair of extensive proximal aortic dissections (Shumway type A/DeBakey type I) can lead to persistent hemorrhage.
- Managing suture line and false lumen bleeding in complex aortic dissections presents significant challenges.
Observation:
- A novel approach involved closing the aortic adventitia and creating a subadventitial anastomosis to the right atrial appendage to control hemorrhage.
- This created a left-to-right aorto-atrial shunt, resulting in a severe low output state.
Findings:
- Percutaneous closure of the aorto-atrial fistula using a detachable balloon successfully corrected the low output syndrome.
- One-year follow-up via computed axial tomographic scanning confirmed the balloon's position, although a persistent para-aortic space communicating with the aorta was noted.
Implications:
- This case highlights a successful, albeit complex, management strategy for intractable hemorrhage following aortic dissection repair.
- Percutaneous fistula closure offers a viable solution for hemodynamically significant aorto-atrial shunts complicating aortic surgery.
- Long-term imaging is crucial to monitor persistent anatomical abnormalities after such interventions.
Abstract:
Surgical repair of an extensive dissection of the proximal aorta (Shumway type A or DeBakey type I) was complicated by persistent haemorrhage from the surgical suture lines and via the false lumen. This was controlled by closing the aortic adventitia round the repaired aorta and by creating an anastomosis between the subadventitial space and the right atrial appendage. Though the haemorrhage was contained, the left to right (aorto-atrial) shunt led to a severe low output state, which was corrected by percutaneous closure of the fistula with a detachable balloon. A year after operation computed axial tomographic scanning showed the balloon in place though the para-aortic space persisted and communicated freely with the aorta.