# Aorto–Right Atrial Fistula Complicating Transseptal Puncture: Integrating Contemporary Imaging and the Structuralist's Toolbox

## TL;DR

This paper describes a successful case of percutaneous closure of a rare heart condition called aorto-right atrial fistula using advanced imaging and specialized techniques.

## Contribution

The paper presents a novel application of multimodal imaging and structuralist techniques for treating a rare iatrogenic heart fistula.

## Key findings

- Computed tomography with 3D reconstructions helped identify the optimal fluoroscopic projection and device alignment.
- A 6/4-mm Amplatzer Duct Occluder was successfully implanted using a jugular venous and femoral arterial approach.
- Percutaneous closure proved to be a feasible and effective treatment for aorto-right atrial fistula.

## Abstract

Aorto–right atrial (RA) fistula is a rare and complex pathological condition, most often occurring as an iatrogenic complication.

We present a case of percutaneous closure of aorto-RA fistula, which resulted from an inadvertent transseptal puncture during atrial fibrillation ablation. Computed tomography with 3-dimensional reconstructions was used to identify the optimal fluoroscopic projection, clarify the anatomy of the fistula, and select the most appropriate closure device. The noncoronary cusp was isolated using the cusp overlap view to optimize device alignment and deployment. A Jugular venous approach in combination with a femoral arterial access allowed us to create an arteriovenous loop. A 6/4-mm Amplatzer Duct Occluder (Abbott) was successfully implanted.

Multimodality imaging has a pivotal role to guide the interventional strategy. Technical skills and experience in structural practice are crucial to achieve a good result.

Percutaneous closure represents a feasible and effective treatment of aorto-RA fistula.