Infective endocarditis of an aorto-right atrial fistula caused by asymptomatic rupture of a sinus of Valsalva aneurysm: a case report

Abstract

Asymptomatic rupture of a sinus of Valsalva aneurysm is rare. A fistula following rupture of a sinus of Valsalva aneurysm may cause infective endocarditis. Here, we report a case of infective endocarditis of an aorto-right atrial fistula caused by asymptomatic rupture of a sinus of Valsalva aneurysm. A 45-year-old male, who was first diagnosed with a heart murmur at the age of 37 years, presented with fever. Blood culture was positive for Streptococcus gordonii. Ultrasound echocardiography revealed an aorto-right atrial fistula caused by rupture of a sinus of Valsalva aneurysm. After the infective endocarditis was healed by antibiotics, we successfully performed surgical repair of the aorto-right atrial fistula. Although asymptomatic rupture of a sinus of Valsalva aneurysm is uncommon, it should be recognized as a possible cause of infective endocarditis.

Keywords: Aorto-right atrial fistula; Infective endocarditis; Sinus of Valsalva aneurysm.

Fig. 1

a Preoperative transesophageal echocardiography showing a windsock-like fistula tract originating in the right coronary sinus protruding into the right atrium (arrow). b String-shaped vegetation was attached to the tip of the windsock-like fistula. c An L-R shunt via the fistula tract was seen. LA left atrium, RA right atrium, RV right ventricle

Fig. 2

Preoperative computed tomography showing a defect between the right coronary sinus and the right atrium (arrow). LA left atrium, RA right atrium, RV right ventricle

Fig. 3

a An intraoperative photograph showing the windsock-like aneurysm being pulled into the sinus of Valsalva (red arrow). b A schema showing the position of the aneurysm, which is located just above the aortic annulus of the right coronary cusp (red circle). c An intraoperative photograph showing the exit into the right atrium, which was surrounded by thickened excessive tissue (blue arrow). d A schema showing the position of the exit into the right atrium, which is located near the anteroseptal commissure of the tricuspid valve, which corresponds with the membranous septum (blue circle)