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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 64-year-old man with a history of saccular aneurysm in the right aortic sinus &#40;RAS&#41; was admitted due to heart failure&#46; Four-dimensional flow magnetic resonance angiography &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A&#8211;C&#41; and transesophageal echocardiography &#40;TEE&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>D&#41; confirmed a fistula over a funnel structure from the RAS to the right atrium &#40;RA&#41; with left-to-right shunt during the whole cardiac cycle&#46; Right catheterization showed a cardiac output of 15 l &#40;Qp&#47;Qs 2&#46;7&#41; and a mean pulmonary pressure of 42 mmHg&#46; The heart team decided on percutaneous closure&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The fistula was crossed with a multipurpose catheter&#44; a hydrophilic guidewire was snared to establish an arteriovenous loop and the delivery system was advanced from the venous aspect&#46; Based on three-dimensional &#40;3D&#41; TEE&#44; we decided to implant an Amplatzer Duct Occluder &#40;ADO&#41;&#44; testing with 12- and 16-mm devices without achieving a stable position or reduction of the shunt&#44; in part due to the inability to deploy the device coaxially to the major axis of the tunnel despite the use of a steerable catheter&#46; Finally&#44; a 12-mm Amplatzer Septal Occluder &#40;ASO&#41; &#40;Abbott Medical&#41; was successfully implanted &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>E and F&#41; with minor peridevice leak &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#44; 3D-TEE aortic view &#91;A&#8211;C&#93; and en-face view &#91;D&#8211;F&#93;&#59; before &#91;A and D&#93;&#44; and after closure &#91;B and C&#59; E and F&#93;&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Although this type of fistula is widely described&#44; percutaneous closure has been reported almost entirely with ADO devices&#46; To the best of our knowledge&#44; this is the first case of percutaneous closure of an RAS to RA fistula with an ASO device&#44; expanding the portfolio available for this procedure&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0020" class="elsevierStylePara elsevierViewall">Drs&#46; Barreiro-Perez and Cruz-Gonzalez are proctors for Abbott Medical&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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