• Online ISSN : 2313-1519
  • Print    ISSN : 1812-2892
Abstract - Does intervention always essential for aorto-right ventricular outflow tract fistula after surgical aortic valve replacement? : A case report
< Back
Ibrahim Halil Inanc


Surgical aortic valve replacement is an effective treatment for symptomatic severe aortic stenosis in patients with low-intermediate operative risk. Prosthetic valve endocarditis is a complication after aortic valve replacement and accounts for 20% of infective endocarditis. Prosthetic valve endocarditis sometimes complicates with abscess formation, pseudoaneurysm and aorto-cardiac fistula. Although severity of symptoms mostly depend on shunt’s size, aorto-cardiac fistula has high mortality rate despite aggressive surgical and percutaneous intervention. Rarely, small shunts can be tolerated. We describe a case of aorto-right ventricle outflow tract fistula presented with signs and symptoms of congestive heart failure and remained asymptomatic under medical therapy.

Key words: aortic valve replacement, pseudoaneurysm, aorto-right ventricle outflow tract fistula

Corresponding author: Dr. Ibrahim Halil INANC. E-mail: dr.ibrahimhalilinanc@outlook.com

ORCID: https://orcid.org/0000-0003-4046-6748



1. Lindman BR, Clavel M-A, Mathieu P, Iung B, Lancellotti P, Otto CM, et al. Calcific aortic stenosis. Nature reviews Disease primers. 2016; 2(1):1-28. https://doi.org/10.1038/nrdp.2016.6


2. Razzolini R, Covolo E. Severe Aortic Stenosis Treatment: Percutaneous Options, Patient Selection, and Preoperative Evaluation. Percutaneous Interventions for Structural Heart Disease: Springer. 2017; 3-13. https://doi.org/10.1007/978-3-319-43757-6_1


3. Glaser N, Jackson V, Holzmann MJ, Franco-Cereceda A, Sartipy U. Prosthetic valve endocarditis after surgical aortic valve replacement. Circulation. 2017; 136(3):329-31.


4. Lalani T, Chu VH, Park LP, Cecchi E, Corey GR, Durante-Mangoni E, et al. In-hospital and 1-year mortality in patients undergoing early surgery for prosthetic valve endocarditis. JAMA internal medicine. 2013; 173(16):1495-504. https://doi.org/10.1001/jamainternmed.2013.8203


5. Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta J-P, Del Zotti F, et al. 2015 ESC guidelines for the management of infective endocarditis: the task force for the management of infective endocarditis of the European Society of Cardiology (ESC) endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). European heart journal. 2015; 36(44):3075-128. https://doi.org/10.1093/eurheartj/ehv319


6. Konda MK, Kalavakunta JK, Pratt JW, Martin D, Gupta V. Aorto-right ventricular fistula following percutaneous transcatheter aortic valve replacement: case report and literature review. Heart views: the official journal of the Gulf Heart Association. 2017; 18(4):133. https://doi.org/10.4103/HEARTVIEWS.HEARTVIEWS_115_16


7. Foster TJ, Amin AH, Busu T, Patel K, Farjo P, Al Hallak A, et al. Aorto-cardiac fistula etiology, presentation, and management: A systematic review. Heart & Lung. 2019; https://doi.org/10.1016/j.hrtlng.2019.11.002


8. Al-Maskari S, Panduranga P, Al-Farqani A, Thomas E, Velliath J. Percutaneous closure of complex paravalvular aortic root pseudoaneurysm and aorta-cavitary fistulas. Indian heart journal. 2014; 66(3):358-62. https://doi.org/10.1016/j.ihj.2014.03.015


9. Anguera I, Miro JM, San Roman JA, de Alarcon A, Anguita M, Almirante B, et al. Periannular complications in infective endocarditis involving prosthetic aortic valves. The American journal of cardiology. 2006; 98(9):1261-8. https://doi.org/10.1016/j.amjcard.2006.05.066



Volume 5, Number 59 (2020)