Spontaneous closure of aorta-to-right atrium fistula after septal occluder implantation.

Catheter-delivered device in closure of atrial septal defect (ASD) by Amplatzer septal occluder (ASO) is a feasible alternative to surgical closure. We present a patient with a perforation of the aorta to right atrium 1 month after implantation of the ASO. Standard occluder placement for symptomatic ASD was performed without complications in a 53-year-old man. One month later a small fistula between aorta and right atrium was noticed during transthoracic echocardiography TTE and confirmed by transoesophageal echocardiography (TEE). The patient refused immediate surgery. After 18 months of observation, an increase in the leak was noticed and the patient agreed to surgery. In TEE performed prior to the surgery, we found a complete self-closure of the leak. After an additional year, the patient did not complain of any symptoms. The ASO procedure seems safe; however, late complications may occur. It is vital to perform regular echocardiographic examinations in follow-up. Spontaneous closures of aorto-atrial fistulas even in long-term observation are possible; nevertheless, surgery still remains the standard procedure in such cases and conservative treatment should be strongly discouraged.