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Aortocardiac fistulas complicating infective endocarditis
I Anguera1, G Quaglio, J M Miró
1Cardiovascular Institute, Department of Microbiology, Institut d'Investigacions Biomèdiques August Pi I Sunyer-Hospital Clinic, University of Barcelona, Spain.
Insights
Infective endocarditis complicated by aortocardiac fistulas is rare but deadly. This study found a 55% mortality rate, even with early surgical intervention for these complex cases.
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.
Abstract:
This study sought to determine the clinical and echocardiographic features, surgical approach, and outcome of patients with infective endocarditis complicated with aortocardiac fistulas among a series of 346 consecutive cases between 1988 and 1998. Nine patients (2%) were found to have aortocardiac fistulas complicating infective endocarditis caused by highly pyogenic pathogens (4 patients had ruptured abscesses of the right sinus of Valsalva, 3 had fistulous communications from the left coronary sinus, and 1 had a fistulized abscess in the noncoronary sinus). Mortality in these patients was very high (55%), even when surgery was attempted early in the course of the disease and reconstructive procedures were implemented.