Premium
Two‐ and Three‐Dimensional Transthoracic Echocardiography in the Assessment of Aortic Arch Vasum Vasi to Pulmonary Artery Fistula
Author(s) -
Sadat Kamel,
Pradhan Manish,
Nanda Navin C.,
Joshi Deepak,
Diddi Hari Prakash
Publication year - 2013
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.12090
Subject(s) - medicine , aortic arch , cardiology , lumen (anatomy) , pulmonary artery , fistula , radiology , aorta
We report an elderly patient presenting with a stroke and also hemolytic anemia secondary to mitral and tricuspid valve repair 3 years earlier, in whom two‐dimensional transesophageal echocardiography (2 DTEE ) suspected a fistula into the pulmonary artery ( APAF ) from the posterior wall of the aortic arch. For further assessment, two‐dimensional transthoracic echocardiography (2 DTTE ) and live/real time three‐dimensional transthoracic echocardiography (3 DTTE ) were performed. 2 DTTE showed findings similar to 2 DTEE . Color D oppler guided continuous‐wave D oppler showed continuous flow throughout the cardiac cycle with systolic preponderance across the fistula with a small peak pressure gradient of 22 mmHg. Sequential systematic cropping of the 3 D datasets obtained from 3 DTTE confirmed that the flow signals originated from the posterior wall of the aortic arch and not the lumen. Thus, 3 DTTE served to increase the confidence level that the fistula most likely originated from a vasum vasi in the wall of the aortic arch. To our knowledge, this type of fistula has not been reported previously. Fistulas from the aortic lumen to the pulmonary artery are also rare and so far only 24 cases have been reported in the literature. These are also reviewed by us.