Abstract
The authors present a case report of a 68-year-old man evaluated at the emergency department for repeated syncope, asthenia, and general malaise, suggesting heart failure in a patient with several comorbidities. At presentation, the patient was afebrile, but he had reported a low-grade fever in the previous six months. At first glance, transthoracic echocardiography was not clear, while transesophageal echocardiography revealed an echo-free image at the level of the non-coronary sinus of the aortic root, suggestive of a pseudoaneurysm, communicating with the right atrium with continuous systo-diastolic flow, compatible with the aorto-cavitary fistula between the aortic root and the RA. Echocardiographic findings were confirmed by cardiac computed tomography. The case was discussed with the heart team and was considered suitable for surgery, but the patient suddenly died just before surgery due to impairment and friability.
Reference19 articles.
1. Fierro EA, Sikachi RR, Agrawal A, et al. Aorto-Atrial fistulas: a contemporary review. Cardiol Rev 2018;26:137-44.
2. Gajjar T, Voleti C, Matta R, et al. Aorta‐right atrial tunnel: clinical presentation, diagnostic criteria, and surgical options. J Thorac Cardiovasc Surg 2005;130:1287‐92.
3. Onorato E, Casilli F, Mbala‐Mukendi M, et al. Sudden heart failure due to a ruptured posterior Valsalva sinus aneurysm into the right atrium: feasibility of catheter closure using the Amplatzer duct occluder. Ital Heart J 2005;6:603‐7.
4. Anguera I, Miro JM, Vilacosta I, et al. Aorto-cavitary fistulous tract formation in infective endocarditis: clinical and echocardiographic features of 76 cases and risk factors for mortality. Eur Heart J 2005;26:288-97.
5. Ananthasubramaniam K, Karthikeyan V. Aortic ring abscess and aorto atrial fistula complicating fulminant prosthetic valve endocarditis due to Proteus mirabilis. J Ultrasound Med 2000;19:63-6.