Acquired left ventricular-right atrial fistula following aortic valve replacement

Intracardiac communications produced as a complication of valve replacement can result in left-to-right shunts and a poor surgical result. The successful surgical closure of a left ventricular-right atrial fistula following aortic valve replacement is discussed. The intricate relationships of the membranous interventricular septum, the aortic, mitral, and tricuspid valves, and the aortic root predispose to the creation of abnormal intracardiac shunts when aggressive debridement of extensive valvular calcification is performed at the time of valve excision and replacement.