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Chronic Traumatic Aortoventricular Fistula Following a Stab Injury: A Case Report.

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A rare aorto-cameral fistula (ACF) in a teen, caused by chest trauma, was successfully repaired. This case underscores the need for high suspicion of post-traumatic cardiac fistulas for early detection and intervention.

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Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Medical Imaging

Background:

  • Aorto-cameral fistula (ACF) is a rare abnormal connection between the aorta and a heart chamber.
  • Causes include trauma, ruptured sinus of Valsalva aneurysms, endocarditis, aortic dissection, or iatrogenic factors.
  • ACF can lead to severe symptoms like heart failure or sudden cardiac death.

Purpose of the Study:

  • To present a case of a 17-year-old female with exertional dyspnea and fatigue.
  • To highlight the diagnostic challenges of chronic traumatic ACF.
  • To emphasize the importance of multimodal imaging and timely surgical intervention.

Main Methods:

  • Transthoracic echocardiography and cardiac CT were used for diagnosis.
  • Surgical repair was performed under cardiopulmonary bypass.
  • The defect was closed using 5-0 Prolene sutures.

Main Results:

  • An 8 mm fistulous connection between the right sinus of Valsalva and the right ventricular outflow tract was identified.
  • Successful surgical closure of the ACF was achieved without residual shunting or aortic valve dysfunction.
  • The patient recovered uneventfully and was discharged on postoperative day four.

Conclusions:

  • Chronic traumatic ACF presents diagnostic challenges, even years after the initial injury.
  • Multimodal imaging is crucial for early detection of post-traumatic cardiac fistulas.
  • Timely surgical intervention is essential to prevent long-term hemodynamic deterioration.