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Echocardiographic evolution of prosthetic aortic valve endocarditis with aorto-left atrial fistula formation

Dimitrios Patsouras1, Thomas Potsis, Konstantinos Siogas

  • 1Department of Cardiology "G. Hatzikosta," General Hospital of Ioannina, Ioannina, Greece.

Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography
|February 4, 2009
PubMed

Insights

Staphylococcus aureus prosthetic valve endocarditis (PVE) can cause aortic paravalvular abscesses. In a rare case, spontaneous drainage formed an aorto-left atrial fistula, leading to patient stabilization.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Medical Imaging

Background:

  • Prosthetic valve endocarditis (PVE) caused by Staphylococcus aureus presents significant morbidity and mortality.
  • Paravalvular abscesses are common in aortic PVE, but fistulas are rare complications.

Observation:

  • An 84-year-old patient with staphylococcal aortic PVE had early diagnosis of paravalvular involvement.
  • High operative mortality risks precluded surgical intervention.
  • The patient experienced unexpected remission of fever and clinical stabilization after spontaneous abscess drainage.

Findings:

  • The spontaneous drainage resulted in the formation of an aorto-left atrial fistula.
  • Transesophageal echocardiography visualized the progression from vegetation to abscess, valve dehiscence, and fistula formation.
  • The fistula formation was associated with clinical improvement.

Implications:

  • This case highlights a rare but potentially stabilizing complication of aortic PVE.
  • Echocardiography is crucial for monitoring the evolution of PVE complications.
  • Non-surgical management of abscess drainage leading to fistula formation may be a viable option in select high-risk patients.

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