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Case Reports
. 2014 Jul 14:9:124.
doi: 10.1186/1749-8090-9-124.

A rare case of sinus of valsalva-right atrial fistula secondary to an abscess perforation from underlying aortic valve endocarditis

Elizabeth S John  1 , Joseph Boyer, Bradford Ledzian, Howard Steward, Richard Moro, Hartmuth B Bittner
Affiliations
Case Reports

A rare case of sinus of valsalva-right atrial fistula secondary to an abscess perforation from underlying aortic valve endocarditis

Elizabeth S John et al. J Cardiothorac Surg. .

Abstract

Sinus of Valsalva-right atrial fistulas are abnormal connections between the aorta and the right atrium, and present challenging surgical conditions. An extremely rare etiology of aorto-right atrial fistula is infective endocarditis. This case report presents a 21 year old Caucasian female patient who had native aortic valve Staphylococcus aureus endocarditis complicated by sinus of Valsalva abscess perforation associated with an acute heart block, an aorto-right atrial fistula, severe heart failure, and cardiogenic shock. She underwent emergent aortic valve replacement and complex sinus of Valsalva fistula pericardial patch reconstruction and repair. This case report further explores the advantages and disadvantages of different valves for different patient populations, and evaluates the patient's prosthesis mismatch and effective orifice area.

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Figures

Figure 1
Figure 1
TEE demonstrated a large aortic valve vegetation (at arrow) and severe aortic regurgitation.
Figure 2
Figure 2
LA: left atrium, AV: Aortic Valve, RV: Right ventricle, RA: Right atrium; the arrow shows an aorto-RA fistula from the perforation between the aorta and the RA.
Figure 3
Figure 3
Blue shaded area: tricuspid regurgitation, gray shaded area: abscess from which the perforation arose; this figure is a cartoon replica of Figure2.
Figure 4
Figure 4
LA: left atrium, AV: Aortic Valve, RV: Right ventricle, RA: Right atrium, arrow: suture knots and pledgets used for repair. This TEE after the surgery shows the repair of the aorto-RA fistula.
See this image and copyright information in PMC

References

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