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Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
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Published on: July 20, 2022

Multimodality imaging of the mitral paravalvular abscess cavity with left ventriculo-atrial fistula

Mustafa Ozan Gürsoy1, Mehmet Özkan, Ahmet Çağrı Aykan

  • 1Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey.

Heart, Lung & Circulation
|April 6, 2012
PubMed

Insights

This study reports a rare case of left ventriculo-atrial fistula in a patient with infective endocarditis and a mechanical mitral valve, visualized using advanced imaging techniques.

Area of Science:

  • Cardiology
  • Medical Imaging

Background:

  • Infective endocarditis can lead to paravalvular complications, with paravalvular abscesses being rare and typically involving the aortic valve.
  • Mechanical prosthetic valves are susceptible to complications, though fistulous tract formation is exceptionally uncommon.

Observation:

  • A unique case of a left ventriculo-atrial fistula developing within a healed paravalvular abscess cavity adjacent to a mechanical mitral valve prosthesis is presented.
  • The fistula was meticulously visualized using a multimodal imaging approach.

Findings:

  • Multimodality imaging, including real-time three-dimensional transesophageal echocardiography (RT-3D TEE), cardiac magnetic resonance imaging (CMRI), and multislice computed tomography (MSCT), confirmed the presence and extent of the fistula.
  • This represents the first documented instance of a left ventriculo-atrial fistula associated with a healed paravalvular abscess in a mechanical prosthetic mitral valve.

Implications:

  • This case highlights the importance of considering rare complications like fistulas in patients with prosthetic valves and a history of endocarditis.
  • Advanced imaging modalities are crucial for the accurate diagnosis and characterization of complex paravalvular complications.
  • Understanding such rare fistulas can inform management strategies for prosthetic valve endocarditis.

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