We report a case in which implantation of a rigid tricuspid annuloplasty ring resulted
in an aorto-atrial fistula. In addition the patient had a series of complications
which had occurred in the perioperative management of the initial operation, characterized
by reoperation for mitral and tricuspidal ring dehiscence, and two reopenings for
bleeding as well as postoperative sepsis. The attempt to close the fistula on the
arrested heart failed. On presentation to our hospital the patient was in decompensated
heart failure (NYHA class IV, ascites and pulmonary edema). Our surgical approach
(fifth resternotomy) consisted of mitral valve replacement under cardioplegic arrest
and re-tricuspid valve repair and closure of the AV fistula on the beating heart.
Postoperatively, the patient was extubated on postoperative day one and discharged
on postoperative day 41 in NYHA class II. Conclusion: Performing a right heart procedure on the beating heart allowed proper identification
of the fistula and easy closure.
Tricuspid valve - echocardiography (all modalities, applications) - aorta/aortic -
heart valve surgery - surgery - complications
