Aortocavitary fistula without aneurysm and transient incomplete atrioventricular block due to infective endocarditis

Abstract

A 67-year-old man with persistent fever and moderate aortic valve regurgitation was transferred. He suffered from incomplete atrioventricular block (AVB), and temporary pacing was needed. Left-to-right shunt flow from the aorta to the right atrium was found without an aneurysm. Operative findings indicated that the aortic valve was highly calcified. The orifice of an aortocavitary fistula (ACF) was detected in the sinus of Valsalva and the right atrium. Patch repair of the aortic annulus with complete débridement of the abscess cavity was performed, a procedure that consisted of aortic valve replacement directly to the Gore-Tex patch and aortic root replacement. His postoperative course was uneventful, but a pacemaker was implanted owing to complete AVB. To our knowledge, this is a rare case in which infective endocarditis was complicated by ACF without an aneurysm of the sinus of valsalva (SV) on the noncoronary cusp to the right atrium and transient incomplete AVB (Mobitz type II) occurring simultaneously.

Aorto-right ventricular fistula following percutaneous transcatheter aortic valve replacement: Case report and literature review

“…Ruptured sinus of Valsalva aneurysm (congenital or traumatic), endocarditis, and complications related to cardiothoracic surgical procedures such as repair of ventricular septal defect, Ross procedure, or modified Ravitch procedure for pectus excavatum have been associated with aorto-ventricular fistula. [ 2 3 4 5 6 ] There are also reports of this complication with surgical aortic valve replacement. The most commonly reported cases of aorto-RV fistulas are secondary to rupture of congenital aneurysm of one of the sinuses of Valsalva.…”

Bivalvular infective endocarditis complicated by perivalvular abscess and aorto-right atrium fistula

“…A combination of two antipseudomonal antibiotics for at least 6 weeks is recommended. Moreover, early surgical consultation in left-sided valvular involvement to replace the valve can result in better outcomes 8–10…”

Association of Heart Block with Uncommon Disease States

“…[10][11][12][13] There is much evidence of septal involvement of the heart with the formation of abscess in infectious diseases such as acute bacterial endocarditis, involving the heart conduction system. [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] Collagen diseases and various types of vasculitis have been postulated as a cause of heart conduction disturbances, as described by Bernstein in humans in 1951 29 and also in an animal model. 30 Calcification of heart valves and valve rings has been shown to destroy the cardiac conduction system 1 and is thus associated with advanced heart block.…”

“…A variety of diseases, other than common coronary artery disease [1][2][3] and Lev-Lenègre syndrome, 4,5 are associated with cardiac conduction system abnormalities. These include acute processes, such as acute rheumatic fever, 6,7 and other disorders such as sarcoidosis, 8,9 Wegenar granulomatosis, [10][11][12][13] bacterial endocarditis with cardiac abscess formation, [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] connective tissue disorder, 29,30 and neoplasms. [31][32][33][34][35][36] Cardiac conduction system abnormality has been documented by electrocardiography with calcification of heart valves and valve rings, 1,37 also following irradiation therapy to the chest, [38][39][40][41][42][43] and after spinal cord injury (SCI), [44][45]…”