Transcatheter closure of an aorta to left atrial fistula with a cocoon membranous ventricular septal defect occluder in a septuagenarian patient.

Aorta-to-left atrial fistula is a rare cardiac anomaly that can be either congenital or acquired. It often presents with symptoms of left heart volume overload and heart failure. Early diagnosis is crucial for effective management. This case report describes a septuagenarian patient with an aorta-to-left atrial fistula. Detailed multimodality imaging was instrumental in establishing the diagnosis. The fistula was successfully closed percutaneously using a Cocoon membranous ventricular septal defect occluder (Vascular Innovations Co. Ltd., Nonthaburi, Thailand). This case emphasizes the importance of a high index of suspicion and comprehensive multimodality imaging for the diagnosis and treatment of this rare condition. Learning objective: Aorta-to-left atrial fistula is a rare but potentially life-threatening cardiac anomaly that can manifest with symptoms of heart failure. Accurate diagnosis requires a high index of suspicion and detailed imaging modalities, such as echocardiography, computed tomographic, and conventional aortography, to precisely identify the fistula's location and size. Even in elderly patients with complex medical histories, percutaneous closure of an aorta-to-left atrial fistula is a viable treatment option. Multidisciplinary care is essential for correct diagnosis and effective management of this condition.