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(Circulation. 1998;98:604.)
© 1998 American Heart Association, Inc.

Images in Cardiovascular Medicine

Aorta-to–Left Atrium Fistula

A Complication of Endocarditis

Arthur Schwartzbard, MD; Paul A. Tunick, MD; ; Itzhak Kronzon, MD

From the Charles and Rose Wohlstetter Noninvasive Cardiology Laboratory, Tisch Hospital, New York University Medical Center, New York, NY.

Correspondence to Paul A. Tunick, MD, NYU Medical Center, 560 First Ave, New York, NY 10016. E-mail paul.tunick@ccmail.med.nyu.edu

A 75-year-old woman was evaluated for endocarditis at New York University Medical Center. She had a history of aortic valve replacement with a bioprosthesis for aortic insufficiency in 1996. Blood cultures were positive for enterococcus. On the second hospital day, the patient abruptly developed hypotension and dyspnea. Physical examination revealed that she was in shock with pulmonary edema, and a continuous murmur was present. An emergency transesophageal echocardiogram was performed at the bedside (Figure).

View larger version (79K): [in this window] [in a new window]   Figure 1. A, Periprosthetic abscess (small arrow) is seen between prosthetic valve and aortic root (A). In addition, a large mobile vegetation (large arrow) is seen extending from abscess into left atrium (LA). B, Color Doppler reveals bright mosaic color jet of high-velocity flow originating within abscess and entering left atrium through vegetation. Jet can be seen curving along lateral left atrial wall, and it continued throughout systole and diastole. C, Continuous-wave Doppler demonstrates continuous shunt. Patient was rushed to the operating room, where she underwent aortic valve replacement and repair of aorta-to–left atrium fistula. However, she died of multisystem failure on second postoperative day.

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke's Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1–267, Houston, TX 77030.

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