RSS-Feed abonnieren
DOI: 10.1055/s-0030-1250647
© Georg Thieme Verlag KG Stuttgart · New York
Surgical Treatment of an Aorto-Right Atrial Fistula as a Complication of Tricuspid Valve Repair
Publikationsverlauf
received October 5, 2010
Publikationsdatum:
15. März 2011 (online)
Abstract
We report a case in which implantation of a rigid tricuspid annuloplasty ring resulted in an aorto-atrial fistula. In addition the patient had a series of complications which had occurred in the perioperative management of the initial operation, characterized by reoperation for mitral and tricuspidal ring dehiscence, and two reopenings for bleeding as well as postoperative sepsis. The attempt to close the fistula on the arrested heart failed. On presentation to our hospital the patient was in decompensated heart failure (NYHA class IV, ascites and pulmonary edema). Our surgical approach (fifth resternotomy) consisted of mitral valve replacement under cardioplegic arrest and re-tricuspid valve repair and closure of the AV fistula on the beating heart. Postoperatively, the patient was extubated on postoperative day one and discharged on postoperative day 41 in NYHA class II. Conclusion: Performing a right heart procedure on the beating heart allowed proper identification of the fistula and easy closure.
Key words
Tricuspid valve - echocardiography (all modalities, applications) - aorta/aortic - heart valve surgery - surgery - complications
References
- 1 Weinrich M, Graeter T P, Langer F, Schafers H J. Left ventricular-right atrial fistula complicating redo mitral valve replacement. Ann Thorac Surg. 2001; 71 343-345
- 2 Aoyagi S, Arinaga K, Oda T, Hori H. Left ventricular-right atrial communication following tricuspid annuloplasty. Eur J Cardiothorac Surg. 2008; 34 680-681
- 3 Moaref A R, Aslani A, Zamirian M, Sharifkazemi M B. Left ventricular to right atrial communication (Gerbode-type defect) after mitral valve replacement. J Am Soc Echocardiogr. 2008; 21 408e1-2
- 4 Tibayan F A, Rodriguez F, Langer F et al. Annular remodeling in chronic ischemic mitral regurgitation: ring selection implications. Ann Thorac Surg. 2003; 76 1549-1554
- 5 Leyh R G, Jakob H. [Current aspects of mitral valve repair in the surgical treatment of mitral valve insufficiency]. Herz. 2006; 31 47-52
- 6 Loop F D. Long-term results of mitral valve repair. Semin Thorac Cardiovasc Surg. 1989; 1 203-210
- 7 Magne J, Girerd N, Senechal M et al. Mitral repair versus replacement for ischemic mitral regurgitation: comparison of short-term and long-term survival. Circulation. 2009; 120 S104-S111
Prof. Torsten Doenst, MD
Department of Cardiothoracic Surgery
Friedrich Schiller University of Jena
Erlanger Allee 101
07747 Jena
Germany
Telefon: +49 3 64 19 32 29 01
Fax: +49 3 64 19 32 29 02
eMail: doenst@med.uni-jena.de