© 2003 by European Society of Cardiology
Copyright © 2003, The European Society of Cardiology
Transoesophageal echocardiographic diagnosis of aortico-left atrial fistula in aortic valve endocarditis
lu*
The Institute of Cardiology, 
stanbul University, stanbul, Turkey
Received 7 June 2002; accepted after revision 25 September 2002.
* Address correspondence to: M. Serdar Küçükolu, FESC, 9 10 K
sm D 15 Blok D:15 Ataköy 34750, stanbul, Turkey. Tel: +90 532 2860797; Fax: +90 212 5294262. kucukoglu3{at}yahoo.com
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Abstract |
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Intra-cardiac fistulas are rarely seen and they are estimated to account for <1% of all cases of infective endocarditis. Fistulization of paravalvular abscesses has been found in 6% to 9% of cases. This is a report of an unusual communication between the abscess region in the aortic root and the left atrium. A 44-year-old patient diagnosed with infective endocarditis had continuous fevers despite antibiotic therapy. Transoesophageal echocardiography revealed multiple vegetations on aortic valve, fistulization of an aortic root abscess to the left atrium and mitral regurgitation and moderate aortic regurgitation. At surgery, multiple vegetations on the aortic valve and a large abscess cavity establishing direct communication between aortic root and the left atrial cavity through a fistulous tract were discovered. This experience demonstrates the improved sensitivity and specificity of transoesophageal echocardiography in defining periannular extension of infective endocarditis.
Keywords: transoesophageal echocardiography; infective endocarditis; fistula; aortic valve