The use of vascular detachable coil for percutaneous closure of iatrogenic aorto-right atrial fistula

We present a 68-year-old men with paroxysmal atrial fibrillation, in whom the aorta was inadvertently punctured while obtaining transseptal access for pulmonary vein isolation. After transseptal sheath had been retracted from the aorta the patient was stable with no pericardial effusion, therefore, the leakage was left to heal. Transoesophageal echocardiography taken 2  months later revealed connection between the non-coronary sinus of Valsalva and the right atrium (RA), which measured 3 mm in diameter (PanelA). Percutaneous closure of the fistula was attempted. The fistula was intubated from the aortic side with a guiding Amplatz Right 2  5-Fr catheter. Two intracoronary wires were passed through the fistula into the RA. With a support of a balloon catheter positioned in the RA, the catheter was able to cross the fistula. The 5-mm detachable coil (MReye® Flipper®, Cook Medical) was implanted, which resulted in immediate leakage blockage (Panel B).
Source: Europace - Category: Cardiology Source Type: research