Shreya Ohri,Mohammad Khurram Nadeem,Sam Seitler,Wasyla Ibrahim,Mohamed Zuhair,Isma Rafiq,Alexander Kempny,Michael Gatzoulis,Nada  Al-Sakini,
Aortic Fistula Plug: A Moving Target
International Journal of Surgical Case Reports
2022
2674-4171
http://dx.doi.org/10.31487/j.IJSCR.2022.01.04
https://www.sciencerepository.org/aortic-fistula-plug_IJSCR-2022-1-104 
Abstract: A middle aged male with history of Fallot type Double outlet right ventricle and coarctation of aorta who underwent multiple surgeries since childhood.  With RV to pulmonary artery conduit and end to end coarctation repair initially, followed by aortic valve, pulmonary valve and RV-PA conduit replacements later. He subsequently developed significant flow through a fistula between a previously coiled aortic pseudoaneurysm and LVOT. This was percutaneously closed with a vascular plug and additionally a PFO, detected, was closed with a device.
Patient returned to the clinic with decompensated heart failure. Updated imaging demonstrated that the plug had migrated and together with the coil, which was impinging on the AVR, resulting in severe supra-valvar AS and continuous significant persistent residual flow across the Aorta- LVOT fistula via false aneurysm. 
Our case highlights the importance of using multimodality imaging for complex congenital heart diseases. In view of high surgical risks associated with previous multiple sternotomies and patient’s preference, percutaneous approaches were adopted initially: however, it was unfortunate to see the migration of vascular plug. After successful deployment of AVP, migration or recanalization is rare, but should not be completely discounted.Keywords: Aortic fistula, vascular plug, vascular coil, congenital cardiac surgery