Aortic Fistula Plug: A Moving Target

A middle aged male with history of Fallot type Double outlet right ventricle and coarctation aorta who underwent multiple surgeries since childhood. With RV to pulmonary artery conduit end repair initially, followed by aortic valve, valve RV-PA replacements later. He subsequently developed significant flow through a fistula between previously coiled pseudoaneurysm LVOT. This was percutaneously closed vascular plug additionally PFO, detected, device. Patient returned the clinic decompensated heart failure. Updated imaging demonstrated that had migrated together coil, which impinging on AVR, resulting in severe supra-valvar AS continuous persistent residual across Aorta- LVOT via false aneurysm. Our case highlights importance using multimodality for complex congenital diseases. In view high surgical risks associated previous sternotomies patient’s preference, percutaneous approaches were adopted initially: however, it unfortunate see migration plug. After successful deployment AVP, or recanalization is rare, but should not be completely discounted.