A rare case of sinus of valsalva-right atrial fistula secondary to an abscess perforation from underlying aortic valve endocarditis

Abstract

Sinus of Valsalva-right atrial fistulas are abnormal connections between the aorta and the right atrium, and present challenging surgical conditions. An extremely rare etiology of aorto-right atrial fistula is infective endocarditis. This case report presents a 21 year old Caucasian female patient who had native aortic valve Staphylococcus aureus endocarditis complicated by sinus of Valsalva abscess perforation associated with an acute heart block, an aorto-right atrial fistula, severe heart failure, and cardiogenic shock. She underwent emergent aortic valve replacement and complex sinus of Valsalva fistula pericardial patch reconstruction and repair. This case report further explores the advantages and disadvantages of different valves for different patient populations, and evaluates the patient’s prosthesis mismatch and effective orifice area.

Type A Quadricuspid Aortic Valve Infective Endocarditis Complicated by Multiple Aortocardiac Fistulae: Case Report and Brief Literature Review

“…They can be congenital, caused by dissecting aneurysms and aortic dissection, secondary to blunt chest trauma, and they can also be seen after cardiac surgery especially operations involving the aorta or the aortic valve. Another cause, which is exceptional, is infective endocarditis (IE) [ 1 , 2 ]. In a multicenter study of 4681 episode of IE, aortocardiac fistulae were diagnosed only in 1.6% of cases [ 4 ].…”

“…Aortocardiac fistulae are exceptionally due to infective endocarditis; they are usually congenital, posttraumatic, or complicate aortic dissection [ 1 , 2 ]. In infective endocarditis setting, the rare presence of aortocardiac fistulae mandates urgent surgery given their poor prognosis [ 3 ].…”

Timing for Pacing after Acquired Conduction Disease in the Setting of Endocarditis

“…While it is indicated to place a pacemaker for complete heart block, the timing of placement for this patient is controversial. There are case reports of other patients with complicated infective endocarditis requiring pacemaker placement but timing seems to be performed with sternotomy or not addressed [ 4 ]. Device infection is of great concern for patients with active systemic infection and timing of the pacemaker may not be best at the operative setting, especially if the patient is hemodynamically able to tolerate their arrhythmia.…”

Aortic Valve Staphylococcus Aureus Endocarditis Complicated by Sinus of Valsalva-Right Atrial Fistula

“…In the case of a mismatch, higher than expected gradients through normally functioning prosthetic valvescan develop resulting in further hemodynamic instability, less regression of ventricular hypertrophy, more cardiac events, and an overall lower survival [5]. Since patient-prosthesis mismatch is a largely preventable cause of failure, it is important to prospectively strategize at the time of operation [6]. Given the patient's acute heart failure and comorbidity, this presented a very challenging situation requiring fast and precise decision-making.…”