Aorto-Right Atrial Fistula Complicating Transseptal Puncture: Integrating Contemporary Imaging and the...

Aorto-right atrial (RA) fistula is a rare and complex pathological condition, most often occurring as an iatrogenic complication.

We present a case of percutaneous closure of aorto-RA fistula, which resulted from an inadvertent transseptal puncture during atrial fibrillation ablation. Computed tomography with 3-dimensional reconstructions was used to identify the optimal fluoroscopic projection, clarify the anatomy of the fistula, and select the most appropriate closure device. The noncoronary cusp was isolated using the cusp overlap view to optimize device alignment and deployment. A Jugular venous approach in combination with a femoral arterial access allowed us to create an arteriovenous loop. A 6/4-mm Amplatzer Duct Occluder (Abbott) was successfully implanted.

Multimodality imaging has a pivotal role to guide the interventional strategy. Technical skills and experience in structural practice are crucial to achieve a good result.

Percutaneous closure represents a feasible and effective treatment of aorto-RA fistula.