Aorto-Right Ventricular Fistula and Vegetation in the Right Ventricle Associated with Infective Endocarditis after Aortic Valve Replacement

(Department of Cardiovascular Surgery, Northern Okinawa Cardiovascular Center, Nago, Japan)

Hiroshi Kumano Keisuke Shuntoh Akimitsu Yamaguchi
We report a rare case of aorto-right ventricular fistula and vegetation in the right ventricle after aortic valve replacement. A 74-year-old woman with a history of aortic valve replacement with a Carpentier-Edwards Perimount pericardial bioprosthesis 7 months earlier was admitted with fever. Methicillin-sensitive Staphylococcus aureus was detected from her blood culture. Transthoracic echocardiography showed an aorto-right ventricular fistula and vegetation in the right ventricle. Under a diagnosis of infective endocarditis, surgery was performed. The operative findings showed a fistula from the previous aortic suture line to the right ventricle, and substantial vegetation in the right ventricular outflow tract. No infective change was observed in the previously inserted prosthetic or pulmonary valves. The vegetation was removed and the fistula was closed directly with a single pledgeted 4-0 prolene mattress suture. The right ventricular outflow tract was reconstructed with a heterogeneous pericardial patch. The patient was discharged in good health on the 59th postoperative day without any infective complications.
  Jpn. J. Cardiovasc. Surg. 40:66-68(2011)

Keywords:aorto-right ventricular fistula, infective endocarditis, aortic valve replacement