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Aorto-cardiac fistulas are defined as a sizable communication between the aorta and cardiac spaces, including the right atrium (RA), right ventricle, left atrium, or left ventricle. Aortoatrial fistula is a rare condition mostly observed as an acquired or extremely rare congenital condition. Causes of the acquired condition are mainly complications of previous cardiac surgery, aortic root abscess due to bacterial endocarditis, paravalvular abscess, ruptured sinus of Valsalva aneurysm, or aortic dissection (1). Congenital cases have poorly defined characteristics with uncertain pathogenesis. Classic signs (continuous murmur) are mostly absent in congenital cases (2). Here we report a case of congenital aorto-right atrial fistula (ARF) with a longer fistula tract. Surgical management is the mostly commonly used treatment option in these cases. In two previously reported cases of ARF originating from the ascending aorta, Amplatzer duct occluder (ADO) I and ADO II were used (3, 4). Our literature review suggested that only two reports on cases of a fistula to the RA originating from the descending thoracic aorta have been published. Surgical and Amplatzer vascular plug II were applied in these cases (5, 6). Here we describe, for the first time, a descending abdominal aorta to the right atrial fistula, which was successfully closed by trans-catheter embolization using an Amplatzer vascular plug IV.

Successful treatment of abdominal aorto-right atrial fistula by vascular plug: A previously unreported cardiac malformation