Skip Navigation

European Journal of Echocardiography 2005 6(1):65-66; doi:10.1016/j.euje.2004.08.009
This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Google Scholar
Right arrow Articles by Walpot, J.
Right arrow Articles by den Braber, J.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Walpot, J.
Right arrow Articles by den Braber, J.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

Copyright © 2005, The European Society of Cardiology

Aorto-right ventricular fistula as an occasional finding

Jeroen Walpot*, Cees Klazen, Raymond Hokken, Jetze Sorgedrager, Martha Hoevenaar and Judith den Braber

Department of Cardiology, Ziekenhuis Walcheren, The Netherlands

Received 26 July 2004; received in revised form 20 August 2004; accepted after revision 24 August 2004.

* Corresponding author. Department of Cardiology, Ziekenhuis Walcheren, Koudekerkseweg 88, Postbus 3200, 4380 DD Vlissingen, The Netherlands. Tel.: +31 118 425000; fax: +31 118 425331. j.m.j.b.walpot{at}walcheren.ziekenhuis.nl


   Abstract
Top
 Abstract
Case presentation
 Discussion
 References
 
Aorto-right ventricular fistulas are defects of the aortic wall in the area above the right coronary cusp, where it separates aorta and right ventricular outflowtract. Often, these injuries are due to trauma or infective endocarditis.

We report an occasional finding of such a fistula, without these causes. There were no other abnormalities on the aortic valve, root or the ascending aorta.

Keywords: Aorto-right ventricular fistula; Transesophageal echocardiography


   Case presentation
Top
 Abstract
 Case presentation
Discussion
 References
 
A 54-year-old man, with an unremarkable medical history, was admitted to the hospital because of stroke. He was treated with aspirin, dipyridamole, statin and low molecular weight heparins. Transthoracic echocardiography could not reveal structural cardiac abnormalities. Holter tape recording could not document atrial fibrillation. During further work-up, transesophageal echocardiography excluded an open foramen ovale, atrial septal defect and intracardiac thrombosis. However, we found a fistula between the aorta above the right coronary cusp, and the right ventricular outflow tract (Figs. 1 and 2Go). The aortic valve was normal without regurgitation. Diameters of the aortic root and ascending aorta were within normal limits. There was no right ventricular overload. Endocarditis prophylaxis and regular cardiac follow-up were recommended.


Figure 1
View larger version (44K):
[in this window]
[in a new window]
[Download PowerPoint slide]
  		Figure 1 TEE image at 135° with small aorto-right ventricular shunt (S). LA=left atrium, LV=left ventricle, AV=aortic valve, MV=mitral valve, AA=ascending aorta, fistula (F).

 


Figure 2
View larger version (36K):
[in this window]
[in a new window]
[Download PowerPoint slide]
  		Figure 2 TEE image at 42° demonstrating the aorto-ventricular shunt (F). LA=left atrium, LV=left ventricle, AV=aortic valve, RV=right ventricle, AA=ascending aorta, S=shunt, PI=pulmonary insufficiency.

 

   Discussion
Top
 Abstract
 Case presentation
 Discussion
References
 
Aorto-cardiac fistulas are relatively rare. Often, they are a complication of trauma or infective endocarditis.1–4

A 2x2cm contact surface between the aorta above the right coronary cusp and the right ventricular outflow tract, is the target area for an aorto-right ventricular fistula.1

In a literature study,1 5 of 18 patients with an aorto-right ventricular fistula due to trauma required emergency exploration because of hemodynamic instability and there was a need for surgery in 17 patients.

In a series3 of 346 consecutive cases of infective endocarditis, 9 patients were found to have an aorto-cardiac fistula. Four of these had a ruptured abscess of the right sinus of Valsalva. Mortality in the patients with aorto-cardiac fistulas was high (55%).

In another series,4 of 106 cases of endocarditis, 6 patients with a cardiac fistula were found and 2 of them had an aorto-right ventricular fistula.

In a literature study5 of 175 cases, the major cause of an aorto-cardiac fistula (76%) was a rupture of a congenital aortic sinus aneurysm.

In conclusion, we report the case of a patient with an aorto-right ventricular fistula as an occasional finding. Neither infective endocarditis, nor trauma was the cause of this lesion. Also, with the exception of aorto-right ventricular fistula, there were no other abnormalities on the aortic valve, the aorta root and the ascending aorta.


   References
Top
 Abstract
 Case presentation
 Discussion
 References
 

  1. Rudstad D.G., Hopeman A.R., Murr P.C., Van Way C.W. 3rd. Aortocardiac fistula with aortic valve injury from penetrating trauma. J Trauma (1986) 26(3):266–270.[ISI][Medline]
  2. Siavelis H.A., Marsan R., Marshall W.J., Maull K. Aortoventricular fistula secondary to blunt trauma: a case report and review from the literature. J Trauma (1997) 43(4):713–715.[ISI][Medline]
  3. Anguera I., Quaglio G., Miro J.M., Pare C., Azqueta M., Marco F., et al. Aortocardiac fistulas complicating infective endocarditis. Am J Cardiol (2001) 87(5):652–654.[CrossRef][ISI][Medline]
  4. Baumgartner F.J., Omari B.O., Robertson J.M., Nelson J.R., Pandya A., Pandya A., et al. Annular abscesses in surgical endocarditis: anatomic, clinical and operative features. Ann Thorac Surg (2000) 70:442–447.[Abstract/Free Full Text]
  5. Rashkind J.W., Norwicki E.R., Aberdeen E., Friedman S. Congenital left aortic sinus-left ventricle fistula and review of aortocardiac fistulas. Ann Thorac Surg (1977) 23(4):378–388.[Abstract]

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?



This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Google Scholar
Right arrow Articles by Walpot, J.
Right arrow Articles by den Braber, J.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Walpot, J.
Right arrow Articles by den Braber, J.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?