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Left ventricular outflow tract to left atrial fistula: A rare long-term complication of the commando procedure

William H Marshall1, Matthew C Henn2, Thura T Harfi1

  • 1The Ohio State University, Department of Internal Medicine, Division of Cardiovascular Medicine, Columbus, Ohio, USA.

Echocardiography (Mount Kisco, N.Y.)
|December 19, 2021
PubMed

Insights

The commando procedure, a complex heart surgery, can lead to rare complications. A 59-year-old patient developed a fistula 5 years after surgery for radiation-induced heart disease.

Area of Science:

  • Cardiology
  • Cardiac Surgery

Background:

  • The commando procedure is a complex surgery involving aortic and mitral valve replacement with aorto-mitral curtain reconstruction.
  • It is indicated for invasive infective endocarditis with abscess or extensive calcification from radiation-induced heart disease.

Observation:

  • Prosthetic valve endocarditis is a known complication, but other long-term outcomes are less reported.
  • A 59-year-old male, 5 years post-commando procedure for radiation-induced heart disease, was incidentally found to have a fistula.

Findings:

  • The patient developed a non-infectious left ventricular outflow tract to left atrial fistula.
  • This fistula was an incidental finding, not related to infection.

Implications:

  • This case highlights the importance of monitoring for rare, non-infectious complications after the commando procedure.
  • Further research into long-term outcomes of this surgery is warranted to improve patient management.

Keywords:
commando procedurefistulatransesophageal echocardiography

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