Aorto-cardiac fistula etiology, presentation, and management: A systematic review

Tianne J. Foster; Ali Hama Amin; Tatiana Busu; Kinjan Patel; Peter Farjo; Abdulrahman Al Hallak; Nyaz Ali; Mohamad Alkhouli

doi:10.1016/j.hrtlng.2019.11.002

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Aorto-cardiac fistula etiology, presentation, and management: A systematic review

Journal article

Peer reviewed

Aorto-cardiac fistula etiology, presentation, and management: A systematic review

Tianne J. Foster, Ali Hama Amin, Tatiana Busu, Kinjan Patel, Peter Farjo, Abdulrahman Al Hallak, Nyaz Ali and Mohamad Alkhouli

Heart & lung, Vol.49(3), pp.317-323

05/01/2020

DOI: 10.1016/j.hrtlng.2019.11.002

PMCID: PMC7962029

PMID: 31735456

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https://www.ncbi.nlm.nih.gov/pmc/articles/7962029View

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Abstract

•Aorto-cardiac fistulae (ACFs) are most commonly caused by iatrogenic or infectious processes.•Patients will commonly present with heart failure, and/or hemodynamic instability.•ACFs are best seen on TEE which has a high sensitivity and specificity.•ACFs are commonly from the aorta to the right atrium or to the pulmonary artery.•Invasive fistula closure appears to be superior to conservative management. Aorto-cardiac fistulae are a rare but increasingly reported entity, and data are scarce. The authors performed a systematic review of ACFs to characterize the underlying etiology, clinical presentation, and compare outcomes of treatment strategies. 3,733 publications were identified in the search. Of those, 292 studies including 300 patients were included. Etiology of ACFs was 38% iatrogenic, 25% infectious, 14% traumatic, and 15% due to other causes. Most patients (74%) presented with heart failure. Common locations were aortic-right atrium (37%), and aortic-pulmonary artery (25%). The majority of patients (71%) were treated surgically, while 13% were treated percutaneously, and 16% were treated conservatively. Patients who were managed conservatively had a higher mortality than those treated with invasive closure (53% vs. 12% vs. 3%, p = <0.00001). This systematic review sheds light on this highly morbid condition. Once recognized, fistula closure appears to be superior to conservative management.

Aortic valve replacement

Aorto-atrial fistula

Aorto-cardiac fistula

Aorto-cavitary fistula

Surgical fistula closure

Transcatheter intervention

Details

Title: Subtitle: Aorto-cardiac fistula etiology, presentation, and management: A systematic review
Creators: Tianne J. Foster - West Virginia University
Ali Hama Amin - Carilion Clinic
Tatiana Busu - West Virginia University
Kinjan Patel - West Virginia University
Peter Farjo - West Virginia University
Abdulrahman Al Hallak - West Virginia University
Nyaz Ali - Carilion Clinic
Mohamad Alkhouli - Mayo Clinic
Resource Type: Journal article
Publication Details: Heart & lung, Vol.49(3), pp.317-323
DOI: 10.1016/j.hrtlng.2019.11.002
PMID: 31735456
PMCID: PMC7962029
NLM abbreviation: Heart Lung
ISSN: 0147-9563
eISSN: 1527-3288
Publisher: Elsevier Inc
Language: English
Date published: 05/01/2020
Academic Unit: Internal Medicine
Record Identifier: 9984691512402771

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