Hepatic encephalopathy due to aorto-right ventricular fistula responsive to percutaneous repair: a case report

BACKGROUND: Encephalopathy due to hyperammonemia is most often found in a setting of cirrhosis. However, it can also result from increased hepatic venous pressures, which can damage zone three hepatocytes and result in elevated serum ammonia. CASE SUMMARY: This report focuses on the unique case of a 43-year-old woman, who presented with confusion in the setting of hyperammonemia due to congestive hepatopathy from an iatrogenic aorto-right ventricular fistula. The patient underwent percutaneous repair of the fistula with resolution of encephalopathy and notable improvement in symptoms. The patient attended all follow-up appointments and was contacted five and eight months after admittance for updates regarding her recovery and permission to publish this case. DISCUSSION: This exceedingly rare case has not been reported in the literature and highlights the historically narrow differential for hyperammonemic encephalopathy given the prevalence of cirrhosis and potential reversibility of such a case.