Aorto–Left Atrial Fistula after Mitral Valve Surgery

Abstract

Case Presentation:A 41-year-old woman was admitted to our outpatient clinic with ongoing dyspnea. She had undergone mitral valve surgery with a 29-mm Carbomedics mechanical prosthetic valve 4 months ago following failed mitral valve repair with ring annuloplasty for rheumatic mitral valve disease. A continuous murmur was heard all over the precordium during physical examination. Laboratory findings were unremarkable, and international normalized ratio (INR) was therapeutic (2.3). Electrocardiography showed sinus rhythm. Transthoracic echocardiography (TTE) showed increased mitral transvalvular gradients (23/ 9 mmHg) (Fig. 1A), and two jets that originated from the aorta (one was aortic regurgitation and the other was fistula to the left atrium) were assessed by color Doppler imaging in the apical five-chamber view (Fig. 1B). Subsequently twodimensional (2D) transesophageal echocardiography (TEE) was performed which showed a continuous regurgitant jet extending from the aorta to Figure 1. Transthoracic echocardiography showed increased transvalvular gradients by continuous-wave Doppler imaging A. and two regurgitant jets that originated from the aorta (one was severe aortic regurgitation, and the other was fistula to the left atrium) were assessed by color Doppler imaging in the apical five-chamber view (arrows) B. LA = left atrium; LV = left ventricle; PMV = prosthetic mitral valve.

Aorto-right pulmonary venous fistula after mitral valve replacement for prosthetic mitral valve infective endocarditis: a case report

“…On the other hand, Raut et al 7 . and Yesin et al 8 . reported cases wherein aorto-LA fistula was detected late following mechanical MVR.…”

Aorto – Left atrial fistula after mitral valve replacement

“…Acquired aorto-LA fistula following MVR is extremely rare and seems related to damage of the coronary cusp during prior surgery 1 . Clinical presentation includes accidental detection, pulmonary edema or chronic heart failure.…”