Review Articles

Aorto-Atrial Fistulas

A Contemporary Review

Fierro, Elizabeth A. OMS-II^*; Sikachi, Rutuja R. MBBS, DNB^†; Agrawal, Abhinav MD^‡; Verma, Isha MD^§; Ojrzanowski, Marcin MD^¶; Sahni, Sonu MD^*‡

Author Information

From the ^*Touro College of Osteopathic Medicine, New York, NY; ^†Department of Anaesthesia, Deenanath Mangeshkar Hospital & Research Center, Pune, Maharashtra, India; ^‡Department of Pulmonary, Critical Care and Sleep Medicine, Hofstra Northwell School of Medicine—Northwell Health System, New Hyde Park, NY; ^§Division of Cardiology, Hartford Hospital, Hartford, CT; and ^¶Department of Cardiology, Bieganski Hospital, Medical University of Lodz, Łódź, Poland.

Disclosure: The authors declare no conflict of interest.

Correspondence: Sonu Sahni, MD, Department of Primary Care, Touro College of Osteopathic Medicine, 230 W 125th Street. New York, NY 10027. E-mail: [email protected].

Cardiology in Review 26(3):p 137-144, May/June 2018. | DOI: 10.1097/CRD.0000000000000182

Abstract

Aorto-atrial fistulas (AAFs) are a relatively rare, but potentially life-threatening condition, where an anomalous connection forms between the aortic structures and the cardiac atria. AAFs are most often the result of an underlying condition concerning the cardiac structures. It may be congenital, secondary to conditions such as aortic dissection, infective endocarditis, or valve replacement, or iatrogenic in nature. Secondary causes incite local deterioration of cardiac wall integrity leading to formation of fistulous connections, whereas iatrogenic causes are more traumatic in nature. Signs and symptoms include those of volume overload and heart failure, with patients often presenting with fever, regurgitative murmurs, cardiac chamber dilation, and pedal edema. The diagnosis of AAFs requires a high degree of clinical suspicion necessitating imaging techniques such as echocardiography, computer tomography, and more invasive procedures. Management is dependent on underlying conditions and include the use of antibiotics, percutaneous closure, and in many cases, open heart surgery. It is important for physicians to be aware of this pathological condition to aid in timely management and favorable outcomes. This review attempts to summarize the various causes and clinical presentations of AAFs over the past decades.