| Summary: | To the Editor, Aorto-atrial fistulas are an extremely rare condition where an abnormal connection forms between the aortic structures and the cardiac atria. Among them, fistulas between the aorta and the left atrium (Ao-LA) are particularly uncommon, and mainly associated with complications like infectious endocarditis, paravalvular abscesses, aortic dissections, and cardiac surgery often damaging the aortic valve or root.1 This is the case of a patient with a iatrogenic Ao-LA fistula successfully treated with a percutaneous Amplatzer device. This is the case of an 82-year-old man admitted to the hospital due to acute heart failure. Three weeks earlier, he had undergone cardiac surgery with mitral and tricuspid valve repair through double annuloplasty plus left anterior descending coronary artery bypass with internal mammary artery graft. The transthoracic echocardiography revealed the presence of a preserved biventricular and valvular function, but also an abnormal systolic and diastolic jet in the left atrium (figure 1A and video 1 of the supplementary data). On the transoesophageal echocardiography this jet corresponded to an Ao-LA fistula through the aortic non-coronary sinus with a significant shunt across it (figure 1B,C and video 2 of the supplementary data). There were no images suggestive of infective endocarditis and repeated blood cultures remained negative...
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