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. 2015:2015:473246.
doi: 10.1155/2015/473246. Epub 2015 Jun 28.

Aortico-Left Atrial Fistula: A Rare Complication of Bioprosthetic Aortic Valve Endocarditis Secondary to Enterococcus faecalis

Abhinav Agrawal  1 , Martin Miguel Amor  1 , Deepa Iyer  2 , Manan Parikh  1 , Marc Cohen  3
Affiliations

Aortico-Left Atrial Fistula: A Rare Complication of Bioprosthetic Aortic Valve Endocarditis Secondary to Enterococcus faecalis

Abhinav Agrawal et al. Case Rep Cardiol. 2015.

Abstract

Paravalvular aortic root abscess with intracardiac fistula formation is an exceedingly rare complication of infective endocarditis. This condition is even more rarely encountered in patients with bioprosthetic valve endocarditis. We report an unusual case of a 68-year-old Bosnian female with a bioprosthetic aortic valve, who developed an extensive aortic root abscess, complicated by an aortico-left atrial intracardiac fistula. This case illustrates that a high index of suspicion, prompt diagnosis by echocardiography, proper antibiotic therapy, and early surgical intervention are crucial to improving treatment outcomes for this rare condition.

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Figures

Figure 1
Figure 1
Transesophageal echocardiogram in short axis (a) and long axis (b) views, showing an extensive aortic root abscess around a bioprosthetic aortic valve, forming a fistulous communication to left atrium (legend: ABSC = abscess, LA = left atrium, MASS = mass in LA, BPAV = bioprosthetic aortic valve, RA = right atrium, AML = anterior mitral leaflet, and LV = left ventricle).
Figure 2
Figure 2
Transesophageal echocardiogram in short axis view with color flow Doppler showing blood flow from the bioprosthetic aortic valve, into the aortic root abscess, which has ruptured into the left atrium, forming an aortico-left atrial fistula.
Figure 3
Figure 3
Transesophageal echocardiogram in long axis view with color flow Doppler showing severe paravalvular aortic regurgitation (indicated by red arrow), around a bioprosthetic aortic valve, around which an extensive aortic root abscess has developed.
See this image and copyright information in PMC

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