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. 2020 Feb 21;4(2):1–5. doi: 10.1093/ehjcr/ytaa039

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© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

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Procedural steps of the catheter-based aorta-right atrial tunnel closure. (A and B) Aortic angiography showing the aorta-right atrial tunnel (white arrow) originating from the right coronary sinus and draining into the right atrium. (C) Advancement from the inferior vena cava of a 7-Fr long sheath over the artero-venous loop towards the ascending aorta. (D) Opening of the distal disc of the closure device (black arrow). (E) Control angiography before full device deployment. (F) Occlusion device correctly positioned inside the aorta-right atrial tunnel (white arrowhead). ARAT, aorta-right atrial tunnel; RA: right atrium.