Author + information
- Received April 28, 2017
- Accepted June 6, 2017
- Published online October 16, 2017.
- aInterventional Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- bNo.1 Echocardiography Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- ↵∗Address for correspondence:
Dr. Wenhui Wu, Interventional Department, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Beijing, China.
A 50-year-old woman with aortic valve stenosis and ascending aorta dilatation underwent composite aortic valve and root replacement (the Bentall’s & Cabrol’s procedure) 8 months before. During the follow-up, computed tomography angiography demonstrated a 4-mm × 7-mm oval leak at the distal anastomosis of the aortic prosthesis to aorta (Figure 1). There was an aorta-to-right atrium fistula caused by the patent Cabrol shunt through the leak. The patient had manifested with symptoms of congestive heart failure for 2 months. The cardiac function was New York Heart Association (NYHA) functional class III.
Transcatheter closure of aortic anastomosis leak (AAL) was attempted in the catheterization laboratory. The short axis of the AAL and the shunt were shown through aortic angiography in the left anterior oblique projection (Figure 2A). Under the guidance of a 5-F JR 4.0 catheter, a 260-cm 0.035-inch guidewire was passed through the leak into the right atrium in a retrograde approach (Figure 2B). The guidewire was then snared, establishing a femoral arteriovenous loop. Several attempts with a 7-F TorqVue (AGA Medical, Saint Paul, Minnesota) sheath to cannulate the ascending aorta in an antegrade manner failed. Hence, the sheath was passed through the leak using a retrograde approach. Considering the oval shape of the leak, a 14-mm × 5-mm Amplatzer Vascular Plug III (AGA Medical) was deployed coaxially to the leak. Post-occlusion angiography showed the AAL was occluded well (Figure 2C). After implanting the occluder, the symptom of dyspnea improved immediately. There was only a trivial residual leak around the occluder on transesophageal echocardiography (Figure 3), and the B-type natriuretic peptide level dropped from 294 pg/ml to 61 pg/ml. The cardiac function was improved to NYHA functional class I.
The AAL is a knotty complication after aortic surgery. Repeat operation, though it is an effective treatment, is associated with high morbidity and mortality rates (1–3). Transcatheter closure might be an alternative option for such intractable cases.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 28, 2017.
- Accepted June 6, 2017.
- 2017 American College of Cardiology Foundation