Aortocardiac fistulas complicating infective endocarditis.

Area of Science:

• Cardiovascular Medicine
• Infectious Diseases
• Cardiac Surgery

Background:

• Infective endocarditis (IE) is a serious infection of the heart lining.
• Aortocardiac fistulas are rare but severe complications of IE, often involving abscesses.
• These fistulas can arise from various aortic sinus locations, posing surgical challenges.

Purpose of the Study:

• To investigate the clinical and echocardiographic features of IE with aortocardiac fistulas.
• To analyze the surgical approaches and outcomes in patients with this complication.
• To determine the mortality associated with IE complicated by aortocardiac fistulas.

Main Methods:

• Retrospective analysis of 346 consecutive infective endocarditis cases (1988-1998).
• Identification and detailed review of nine patients (2%) with aortocardiac fistulas.
• Evaluation of clinical presentation, echocardiographic findings, surgical procedures, and outcomes.

Main Results:

• Nine patients (2%) presented with aortocardiac fistulas complicating infective endocarditis.
• Fistulas originated from the right sinus of Valsalva (4), left coronary sinus (3), and noncoronary sinus (1).
• High mortality rate of 55% was observed, irrespective of early surgery or reconstructive efforts.

Conclusions:

• Aortocardiac fistulas are a rare, highly lethal complication of infective endocarditis.
• The origin of the fistula (e.g., sinus of Valsalva) influences presentation.
• Despite aggressive surgical management, mortality remains exceedingly high, underscoring the severity of this condition.