A 23-year-old lady from Tripura with a three-year history of effort dyspnea and palpitations was referred for evaluation. Cardiovascular examination revealed continuous murmur at left upper parasternal area. She underwent a successful catheter-based intervention, where the team of doctors put an umbrella-shaped special device called Amplatzer Vascular Plug (AVP) instead of carrying out a surgery correction, at a Kolkata hospital recently.
“It was a structural disorder of heart which is very rare in nature. Since we ensure patient-centred treatment plans, we neither recommended surgical operation nor blood transfusion. Heart care is in the midst of a transformation,” says Cardiac Surgeon Dr Kunal Sarkar, Senior Vice-Chairman, Medica.
It was indeed a good decision on part of Medica heart team. The procedure was initiated with local anaesthesia by putting AVP inside the heart. The patient is recovering fast. “Without surgery, the patient is doing well now. Bearing children in future would be normal for her, considering that she is just 23 years old,” says Dr Rabin Chakraborty, Senior Vice-Chairman, Cardiology Services, Medica.
This is a rare congenital abnormality from birth and in such cases the blood is to be shunted from aorta to right side of the chamber of the heart. Management of this type of congenital (inherited) aortocameral fistula is generally done by surgical correction but non-surgical device intervention has recently been introduced as a safe alternative, explains Dr Rabin Chakraborty.
The aorto-atrial fistula is a rare variant of congenital aorto-cameral fistula, most frequently originating from left coronary sinus. This case emphasizes the role of percutaneous closure of this congenital cardiac anomaly.
“To our best knowledge, it was the first case of aorto-RA fistula where AVP was used. Large available sizes and easy antegrade deliverability made this device appropriate in this large fistula. It is a rare manifestation of aorto-right atrial fistula successfully closed by AVP and this device is used for the first time for this kind of case, says Dr Soumya Patra elucidating further.
The entire procedure took around two hours and the patient was discharged happily after two days.
After investigating the patient, the heart team doctors came to a consensus on the line of treatment, ensuring a rational approach with evidence-based medicine for better outcomes. “Skill and efficiency are the examples of this case,” concluded Dr Alok Roy, Chairman, Medica Group of Hospitals.