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Published on: June 14, 2017
Aorto-right pulmonary venous fistula after mitral valve replacement for prosthetic mitral valve infective
Kazuhito Hirata1, Asako Fukuyama1, Toshiho Tengan2
1Division of Cardiology, Okinawa Chubu Hospital, 281 Miyazato, Uruma, Okinawa, Japan.
Background:
Aorto-cavitary fistula is a rare condition, and the most common underlying aetiology is infective endocarditis (IE) of the native or the prosthetic aortic valve. We report a case of aorto-right inferior pulmonary venous fistula following redo mitral valve replacement (MVR) for prosthetic mitral valve IE.
Case Summary:
A 74-year-old woman underwent urgent redo MVR for prosthetic mitral valve IE. The post-operative course was complicated with heart failure and mediastinal haematoma compressing the left atrium. The haematoma was surgically removed and laceration of the left atrial wall was suture ligated; this was attributed to the surgical trauma dissection of the adhesive tissues. One-week post-operatively, a continuous murmur emerged, which prompted an evaluation of the left to right shunt. Transthoracic echocardiography revealed an echolucent area posterior to the aorta, with continuous flow on colour Doppler. Three-dimensional computed tomography showed a fistula between the aorta and the right inferior pulmonary vein. There was a high risk involved in surgical management; therefore, she was managed medically. Fortunately, the continuous murmur and echolucent space disappeared after 6 months. The fistula was considered to be obstructed by spontaneous thrombus formation in the narrowed segment of the fistula tract.
Discussion:
The cause of fistula was attributed to possible surgical trauma in the presence of infection. The present case was unique, as it showed spontaneous healing of an aorto-cavitary fistula, which is very rare. The patient was alive with good health status, 6 years after the MVR.
Insights
This case report details a rare aorto-right inferior pulmonary venous fistula after mitral valve replacement. The fistula, likely caused by surgical trauma and infection, spontaneously healed, a highly unusual outcome for aorto-cavitary fistulas.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Radiology
Background:
- Aorto-cavitary fistula is a rare complication, often linked to infective endocarditis (IE) of prosthetic or native valves.
- Prosthetic mitral valve IE can lead to serious complications, including aorto-cavitary fistulas.
Purpose of the Study:
- To report a unique case of an aorto-right inferior pulmonary venous fistula following redo mitral valve replacement.
- To highlight the spontaneous healing of an aorto-cavitary fistula, a rare occurrence.
Main Methods:
- A 74-year-old female underwent urgent redo mitral valve replacement for prosthetic mitral valve IE.
- Post-operative complications included heart failure and mediastinal hematoma, requiring surgical intervention.
- Diagnosis of the aorto-right inferior pulmonary venous fistula was confirmed using transthoracic echocardiography and 3D computed tomography.
Main Results:
- A rare aorto-right inferior pulmonary venous fistula was identified post-redo mitral valve replacement.
- The patient was managed medically due to high surgical risk.
- Spontaneous closure of the fistula was observed after 6 months, attributed to thrombus formation.
Conclusions:
- Surgical trauma in the context of infection is the presumed cause of this aorto-cavitary fistula.
- Spontaneous healing of aorto-cavitary fistulas is exceptionally rare.
- The patient remained in good health 6 years post-procedure, demonstrating a favorable long-term outcome.
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