Left ventricular outflow track to left atrium fistula: a complication of enterococcal endocarditis and long-term...

Area of Science:

• Cardiology
• Infectious Diseases
• Cardiac Surgery

Background:

• Infective endocarditis, particularly from Enterococcus faecalis, can lead to severe valvular damage.
• Rare complications include secondary infections of adjacent cardiac structures, such as the mitral aortic intervalvular fibrosa.
• Torrential aortic regurgitation and pseudoaneurysm formation are critical manifestations.

Purpose of the Study:

• To describe a rare case of Enterococcus faecalis infective aortic valve endocarditis.
• To highlight the complex secondary infections and structural damage, including abscess and pseudoaneurysm.
• To present the surgical and conservative management strategies employed.

Main Methods:

• Case report detailing clinical presentation, diagnostic imaging, and microbiological findings.
• Surgical intervention involving aortic valve replacement, mitral aortic fibrosa repair, and aortic pseudoaneurysm repair.
• Conservative management of a persistent mitral valve fistula post-surgery.

Main Results:

• Successful surgical repair of the aortic valve, mitral aortic fibrosa, and aortic pseudoaneurysm.
• Development of a fistulous connection between the left ventricular outflow tract and left atrium due to mitral valve abscess rupture.
• Persistent mitral valve fistula managed conservatively with clinical stability.

Conclusions:

• Enterococcus faecalis endocarditis can present with rare and complex complications affecting multiple cardiac structures.
• Multifaceted surgical and conservative approaches may be necessary for managing these severe sequelae.
• Early recognition and intervention are crucial for improving outcomes in complicated infective endocarditis.