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Case Reports
. 2020 Jun;14(8):e01233.
doi: 10.1213/XAA.0000000000001233.

Aorto-Left Atrial Fistula as Sequela of Endocarditis

Abimbola O Faloye  1 , Mckenzie M Hollon
Affiliations
Case Reports

Aorto-Left Atrial Fistula as Sequela of Endocarditis

Abimbola O Faloye et al. A A Pract. 2020 Jun.

Abstract

Aortoatrial fistula formation is a rare complication of bacterial endocarditis. Fistulous tracts may form between the aorta and either atrium. Clinical presentation varies from an insignificant murmur to refractory congestive heart failure. Most clinically relevant fistula manifests with acute and severe symptoms. Transesophageal echocardiography (TEE) is more sensitive than transthoracic echocardiography (TTE) in diagnosing intracardiac shunts, and invaluable in guiding intraoperative surgical repair. Definitive therapy involves closure of the fistula either through an open surgical approach or percutaneously with an occluder device.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1.
Figure 1.
Midesophageal 5-chamber view in 2 dimensions showing a prolapsed left coronary cusp and a juxtaposed mass in the left atrium.
Figure 2.
Figure 2.
A, ME AV LAX view in 2 dimensions showing prolapsed left coronary cusp and fistula tract with flap protruding into the left atrium. B, ME SAX AV showing an area of lucency next to the left coronary cusp, with flap from aortic root protruding into left atrium. AV indicates aortic valve; LAX, long-axis; ME, midesophageal; SAX, short axis.
Figure 3.
Figure 3.
A, ME AV LAX view in 2 dimensions with color Doppler in systole showing mitral regurgitation and flow from aorta into left atrium. B, ME LAX AV view in 2 dimensions with color Doppler in diastole showing aortic regurgitation and flow from aorta into left atrium. AV indicates aortic valve; LAX, long-axis; ME, midesophageal.
See this image and copyright information in PMC

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Supplementary concepts