Page 28 - Journal of Structural Heart Disease Volume 3, Issue 3

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Meeting Abstracts
Figure 1.
Figure 2.
The closure of an aorta-right atrial tunnel is recommended even in asymptomatic patients as there is only a low rate of procedural complications.
The continued patency of the tunnel leads to risk for biventricular volume overload, bacterial endocarditis, pulmonary vascular disease, aneurysm formation, calci cation of the wall, aortic regurgitation and spontaneous rupture.
Treatment options are available according to the type of tunnel, its caliber, tortuosity, calci cation, course and relation of the coronary ostia to the aortic ori ce of the tunnel. They include:
1. Transcatheter closure
2. Ligation under controlled hypotension or repair with the patient under cardiopulmonary bypass
In this case, a transcatheter treatment is the option of choice due to the small opening of the right atrial end.
Placement of the Occluder Device:
• The right femoral vein and artery were cannulated using 6Fr sheaths
using standard procedure & the patient was heparinized
• 6F Judkins catheter advanced retrogradely via the ascending aorta and cannulated the ostium of the ARAT from a peripheral access point
• A long Terumo glide wire 0.032 x 260 mm was used to cross the ARAT from the aorta to the RA, RV and to the MPA
• Snare system was inserted antegradely via the right femoral vein up to the MPA. The terumo glide wire was then pulled out by the snare to the right femoral vein
• An arteriovenous guide wire splint was then created
• The CDC6F delivery sheath with introducer was advanced over the
wire to the IVC, RA, & to the tunnel
• The dilator & wire were then gently removed
• A 10/12 mm Cocoon PDA device occluder was then deployed at the
exit site of the ARAT at the RA side
• Cineangiography post occlusion of ARAT showed the device posi-
tioned within the tunnel exit, with minimal shunting of contrast in
the center of the device
• Device was then released from the delivery cable
Post intervention, there was no aortic insu ciency noted. The patient tolerated the procedure well and was discharged home after 24 hours of the procedure.
Hijazi, Z
20th Annual PICS/AICS Meeting Abstracts