1. Repair of Aortic–Left Atrial Fistula Following the Transcatheter Closure of an Atrial Septal Defect 
Dennis M. Mello, MD, John Fahey, MD, Gary S. Kopf, MD 
The Annals of Thoracic Surgery 
Volume 80, Issue 4, Pages (October 2005)
DOI: /j.athoracsur
Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

2. Fig 1
Schematic drawing of the base of the heart showing how a rigid atrial septal defect device placed in the superior-anterior atrial septum could impinge on the aortic root. (ANT = anterior; Circ. = circumflex; LA = left atrium; LAD = left anterior descending artery; LV = left ventricle; LCC = left coronary cusp; LMCA = left main coronary artery; MV = mitral valve; NCC = noncoronary cusp; POST = posterior; RA = right atrium; TV = tricuspid valve; RCA = right carotid artery; RCC = right coronary cusp; RV = right ventricle).
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

3. Fig 2
Left ventricular angiogram in the left anterior oblique view showing the fistula (arrow) between the aortic root and the left atrium (LA). (AO = aorta; LV = left ventricle.)
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

4. Fig 3
(A) A probe placed from the aortic root through the fistula into the left atrium (LA). The atrial septal defect device has been retracted anteriorly to show the left atrium. (RA = right atrium.) (B) View from the anesthesia screen showing the fistula (arrow) in the noncoronary sinus of Valsalva with the probe through it. The aortic cross-clamp is at the bottom of the picture. (LCC = left coronary cusp; NCC = noncoronary cusp.)
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

5. Fig 4
The Amplatzer septal occluder (ASO) used to repair the atrial septal defect has been retracted into the right atrium showing its left atrial (LA) side with thrombus formation (arrow)on the device near the site of the fistula.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

6. Fig 5
(A) Monofilament sutures are placed from the aortic root into the left atrium and tied in the left atrium to obliterate the fistula. Care is taken to avoid injury to aortic leaflet. (AO = aortic opening; LA = left atrium; LCC = left coronary cusp; NCC = noncoronary cusp; RA = right atrium; RCC = right coronary cusp; SVC = superior vena cava.) (B) Additional sutures are placed from the left atrial side to reinforce closure and reendothelialize the denuded portion of the left atrium. (C) Patch closure of atrial septal defect (ASD).
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions