Aorto-right atrial fistula: Late complication of tricuspid valve infective endocarditis

Abstract

Abnormal connections between the ascending aorta and the cardiac chambers are rare, especially in the context of right-sided infective endocarditis (IE). Transthoracic echocardiography (TTE) with color-flow Doppler, transesophageal echocardiography (TEE), or both may be required for diagnosis. We present the case of a woman admitted with right-sided heart failure (HF) symptoms. She had a previous history of tricuspid valve IE 30 years ago. TTE and TEE revealed an aorto-right atrium fistula located just under the non-coronary cusp into the right atrium at the level of the previously affected tricuspid valve. The Patient refused surgery and was discharged home on HF medications. She has been stable for the last 3 years. The peculiarity of this case is the late symptomatic presentation of the aorto-atrial fistula and the unusual association to tricuspid valve IE.

Aorto-Right Atrial Fistula after Minimally Invasive Tricuspid Valve Repair: A Report of Two Cases

“…It was reported that aorto-cardiac fistula occurred with infective endocarditis, blunt trauma, stab wound to the chest, ruptured aneurysms of the sinus of Valsalva, aortic dissection, congenital disorder, cardiac valve surgery, percutaneous cardiac valve implantation, heart transplantation, and autoimmune vasculitis. 1 In our cases, annular debridement was not performed, and there were no symptoms of infective endocarditis near the tricuspid valve. In addition, ARAF showed only in postoperative examination.…”

Simultaneous Right-Sided and Left-Sided Infective Endocarditis: Management Challenges in a Multidisciplinary Setting

“…Clinically, large aortic fistulae can present with heart failure. 24 In this patient, the aortic fistula appeared small and likely did not contribute significantly to the patient's presenting symptomatology. The chest pain in this scenario likely was due to myocardial ischemia from septic coronary emboli, also explaining the apical akinesis noted on preoperative TTE.…”

A Shortcut to Death: Aorto–Left Atrial Fistula in the Setting of MRSA Infective Endocarditis

“…As the infection spreads to surrounding tissue, it inflames and weakens the myocardium, slowly eroding a path in the form of a fistula into a nearby space, such as the atrium. 3 Our literature suggests that 51.7% of AAF formations open into the right atrium. 4 Interestingly, the junctional zone between the mitral and aortic valve annulus, known as the mitral-aortic intervalvular fibrosa, is, unfortunately, ideal for abscess formation given its relative hypovascularity.…”