English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools annual

Global: Zendy Free Plan

Global: Zendy Tools monthly

Global: Zendy Plus monthly

A 12-year-old girl with a 4-year history of effort dyspnea and palpitations was referred to our institution for evaluation. Physical examination of the patient showed a continuous grade 3/6 heart murmur best heard along the right upper sternal border. A two-dimensional echocardiogram exhibited a small interatrial septal defect (diameter, 4 mm) with a bidirectional shunt and a high velocity jet in the dilated right atrium. A computed tomographic (CT) angiogram of the patient showed anomalous tortuous communication between the ascending aorta and the right atrium arising adjacent to the right coronary artery (Fig. 1). An ascending aortogram combined with selective angiography confirmed the presence of a large fistula with a broad origin (diameter, 5.6 mm) from the right aortic sinus anterior to the right coronary artery and a narrow termination into the posterior wall of the right atrium (Fig. 2). Cardiac catheterization showed the presence of a left-toright shunt with a pulmonary-to-systemic blood flow ratio (Qp:Qs) of 3:1. Coronary angiography demonstrated normal coronary arteries arising from the respective sinuses. Because the fistula had a separate anterior origin and a narrow terminal ending into the right atrium, a decision was made in favor of transcatheter device closure. The fistula was hooked antegradely using an Amplatzer right 1 (AR-1) catheter (Medtronic Inc., Minneapolis, MN, USA), and a standard percutaneous transluminal coronary angioplasty (PTCA) guidewire balance middle weight (BMW) was passed through the tortuosity of the fistula toward the right atrial end. The wire then was retrieved from the right atrial end with a snare and exteriorized from the right femoral vein. A long sheath available with the device then was passed through the right femoral venous route to the right atrium. An Amplatzer duct occluder (AGA Medical Corporation, Plymouth, MN, USA) size 8 9 6 mm was chosen for closure of the fistula and passed through the sheath with the help of the Amplatzer 1808 delivery system (Fig. 3). The fistula was successfully closed using the occluder with its large end placed through the fistula toward the aortic side. After deployment of the device, no residual flow through the fistula was demonstrated (Fig. 4).

Congenital Aorta Right Atrial Fistula: Successful Transcatheter Closure With the Amplatzer Occluder