Published online Oct 26, 2014. doi: 10.4330/wjc.v6.i10.1122
Revised: June 1, 2014
Accepted: July 25, 2014
Published online: October 26, 2014
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.
Core tip: Aorto-cardiac fistulas are rare, usually associated to prosthetic aortic valve infective endocarditis. The median duration of symptoms to echocardiographic detection of fistulization is about one month. We present a case of aorto-atrial fistula at late presentation, 30 years after tricuspid valve infective endocarditis. This article describes the epidemiology, clinical manifestations, pathophysiology, diagnostic modalities, treatment and outcomes of aorto-cardiac fistulas.