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An acquired interatrial fistula secondary to para-aortic abscess documented by transesophageal echocardiography
R C Sheppard1, K Chandrasekaran, J Ross
1Department of Cardiology, Likoff Cardiovascular Institute, Hahnemann University Hospital, Philadelphia, PA 19102.
Abstract:
Para-aortic ring abscess and resulting fistulous communication between adjacent structures frequently occur in prosthetic aortic valve endocarditis but are rarely diagnosed preoperatively. We report a patient who had an abscess involving the aortic-mitral intervalvular fibrosa that eroded into the interatrial septum, causing an interatrial communication with a left-to-right shunt. The abscess was detected by transthoracic echocardiography, but the fistula was only seen by the subsequent transesophageal echocardiogram. To our knowledge, this is the first report of an interatrial fistula secondary to a para-aortic valve abscess and its diagnosis preoperatively. Transesophageal echocardiography should be performed in any patient suspected to have complicated aortic endocarditis.
Insights
Aortic valve endocarditis can cause rare para-aortic abscesses. This case highlights the first preoperatively diagnosed interatrial fistula resulting from such an abscess, detected via transesophageal echocardiography.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Imaging
Background:
- Prosthetic aortic valve endocarditis frequently leads to para-aortic ring abscesses.
- Fistulous communications are common complications but rarely diagnosed preoperatively.
Observation:
- A patient presented with an abscess in the aortic-mitral intervalvular fibrosa.
- The abscess eroded into the interatrial septum, creating an interatrial communication.
- Transthoracic echocardiography detected the abscess, while transesophageal echocardiography revealed the fistula.
Findings:
- This is the first reported case of an interatrial fistula secondary to a para-aortic valve abscess.
- The fistula resulted in a left-to-right shunt.
- Preoperative diagnosis was achieved using advanced echocardiographic techniques.
Implications:
- Transesophageal echocardiography is crucial for diagnosing complicated aortic endocarditis.
- Early detection of such fistulas can guide surgical and medical management.
- This case expands understanding of rare endocarditis complications.