A 23-year old lady from Tripura with a 3-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 city hospital recently.
Patient Umrao Bano (name changed on request), had an abnormal vascular channel connecting the right coronary artery and right atrium called congenital (inherited) aortocameral fistula. Umrao consulted the Medica Heart Team doctors comprising Interventional Cardiologists and Cardiac Surgeons together. The doctors met the patient together at-the-same-time and collectively advised her family that the catheter-based intervention would be a safer and best option than a surgical procedure, a hospital release said
The team of doctors include renowned Cardiac Surgeon Dr. Kunal Sarkar, Senior Vice-Chairman, Medica, Prof. (Dr.) Rabin Chakraborty, Senior Vice-Chairman, Cardiology Services, Medica, consultants Dr. Soumya Patra, Dr. Sumanto Mukhopadhyay and Dr. Arindam Pande. “When she was admitted at Medica, she compliant of shortness of breath and palpitation, which she actively felt from last 2-3 years,” said the team of doctors.
“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,” said Cardiac Surgeon Dr.Sarkar.
It was indeed a good decision on part of Medica Heart Team. The procedure was initiated with local anaesthesia by putting a special umbrella-shaped device called ampletzer vascular plug inside 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,” said Dr. Rabin Chakraborty.
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, explained 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, said Dr. Soumya Patra elucidating further.
The entire procedure took around 2 hours and the patient was discharged happily after 2 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.