Aorto-right ventricular fistula as an occasional finding - EHJ ...

66 J. Walpot et al.
Figure 1 TEE image at 135( with small aorto-right
ventricular shunt (S). LA Z left atrium, LV Z left ventricle,
AV Z aortic valve, MV Z mitral valve, AA Z ascending
aorta, fistula (F).
In a literature study, 1 5 of 18 patients with an
aorto-right ventricular fistula due to trauma
required emergency exploration because of
hemodynamic instability and there was a need
for surgery in 17 patients.
In a series 3 of 346 consecutive cases of infective
endocarditis, 9 patients were found to have an
aorto-cardiac fistula. Four of these had a ruptured
abscess of the right sinus of Valsalva. Mortality in the
patients with aorto-cardiac fistulas was high (55%).
In another series, 4 of 106 cases of endocarditis,
6 patients with a cardiac fistula were found and 2
of them had an aorto-right ventricular fistula.
In a literature study 5 of 175 cases, the major
cause of an aorto-cardiac fistula (76%) was a rupture
of a congenital aortic sinus aneurysm.
In conclusion, we report the case of a patient
with an aorto-right ventricular fistula as an occasional
finding. Neither infective endocarditis, nor
trauma was the cause of this lesion. Also, with the
Figure 2 TEE image at 42( demonstrating the aortoventricular
shunt (F). LA Z left atrium, LV Z left ventricle,
AV Z aortic valve, RV Z right ventricle, AA Z
ascending aorta, S Z shunt, PI Z pulmonary insufficiency.
exception of aorto-right ventricular fistula, there
were no other abnormalities on the aortic valve,
the aorta root and the ascending aorta.
References
1. Rudstad DG, Hopeman AR, Murr PC, Van Way 3rd CW.
Aortocardiac fistula with aortic valve injury from penetrating
trauma. J Trauma 1986;26(3):266e70.
2. Siavelis HA, Marsan R, Marshall WJ, Maull K. Aortoventricular
fistula secondary to blunt trauma: a case report and review
from the literature. J Trauma 1997;43(4):713e5.
3. Anguera I, Quaglio G, Miro JM, Pare C, Azqueta M, Marco F,
et al. Aortocardiac fistulas complicating infective endocarditis.
Am J Cardiol 2001;87(5):652e4.
4. Baumgartner FJ, Omari BO, Robertson JM, Nelson JR, Pandya
A, Pandya A, et al. Annular abscesses in surgical endocarditis:
anatomic, clinical and operative features. Ann Thorac Surg
2000;70:442e7.
5. Rashkind JW, Norwicki ER, Aberdeen E, Friedman S.
Congenital left aortic sinus-left ventricle fistula and review
of aortocardiac fistulas. Ann Thorac Surg 1977;23(4):378e88.
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