Abstract
Aorto-caval fistula (ACF) is a rare cause of high output heart failure (HOHF). 80 % of cases are due to ruptured abdominal aortic aneurysm, while 10 to 20% are traumatic or congenital. Early diagnosis and treatment are crucial in order to prevent the progression to HOHF. Open surgical repair has been the mainstay therapy of arterio-venous fistulas including aorto-caval fistula; however endovascular approach has become an evolving therapeutic option in the last 20 years. Here, we present a case of high output heart failure secondary to traumatic aorto-caval fistula due to shrapnel injury to the abdomen. Our patient was managed with endovascular approach by the deployment of amplatzer septal occluder that excluded completely the fistula, resulting in the progressive improvement of HOHF. In this manuscript, we review etiologies of high output heart failure and summarize cases of aorto-caval fistula treated with amplatzer septal occluder reported in literature. We also highlight the importance of this endovascular device in the presence of metallic foreign body in the aorta.
Highlights
High output heart failure (HOHF), unlike other forms of heart failure, is defined as cardiac output (CO) greater than 8L/min or cardiac index (CI) greater than 4.0 L/min/m2 along with a low systemic vascular resistance [1]
Open surgical repair has been the mainstay therapy of arterio-venous fistula (AVF), the endovascular approach, which was first described in 1999 [4], has become an evolving therapeutic option in the last 20 years with lower mortality and morbidity rate compared to the conventional surgical approach [5]
Complete exclusion of the Aorto-caval fistula with stable position of the amplatzer septal occluder at 6 months follow up aorto-caval fistula (ACF) is one of the very rare causes of HOHF. 80-90% of ACF are due to ruptured abdominal aortic aneurysm (AAA) into the inferior vena cava, the incidence is only 2-7% of all cases of AAA; while traumatic and iatrogenic causes represent 10-20% [8]
Summary
High output heart failure (HOHF), unlike other forms of heart failure (reduced or preserved ejection fraction), is defined as cardiac output (CO) greater than 8L/min or cardiac index (CI) greater than 4.0 L/min/m2 along with a low systemic vascular resistance [1]. A computed tomography angiography of the abdomen (CTA) showed an ACF of (1.2 cm) of a diameter just above the aortic bifurcation with severe dilatation of the inferior vena cava (46 mm) and the right iliac vein, we noted the presence of remaining shrapnel in the aorta [Figure 3, 4]. Repeat echocardiogram showed markedly decreased diameter of right heart cavities, inferior vena cava (26 mm), improvement of right ventricular systolic function (TAPSE 18 mmHg), and disappearance of tricuspid regurgitation. Exclusion of the fistula with mild endoleak and well positioned ASO
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
