The Futile Heart

Abstract

In complex cases (i.e., aorto-right atrial fistula), in order to obtain a complete understating of the clinical picture and possibly recommend appropriate treatments, a thorough investigation is required with attention to technical details that can influence the various calculations and quantifications utilized. Combining all available echocardiographic data—m-mode, 2D, Doppler, 3D—can prove invaluable for understanding the hemodynamics in certain situations. Detailed echocardiographic evaluation can provide important information and be key to making a clinically important diagnosis. Any calculation utilized should be thought of and the information obtained from it should be understood in the larger context, and interpreted accordingly.

A significant aorta to right atrium fistula can be thought of as the “futile heart”—all four chambers and pulmonary circulation are exposed to volume overload while the systemic circulation is at a low cardiac output state. Echocardiography can identify the presence and severity of such a condition and help guide appropriate treatment.