Aorto-Right Atrial and Aorto-Right Ventricular Fistulas as a Complication of Subacute Infective Endocarditis.

Aorto-atrial fistula (AAF) and aorto-ventricular fistula (AVF) are a rare, but potentially life-threatening condition, where an anomalous connection forms between the aortic structures and the cardiac atria or ventricles. The exact incidence of this condition is unknown, as are the major precipitating factors and best treatment options. It may be congenital, secondary to conditions such as aortic dissection, infective endocarditis, or valve replacement, or iatrogenic in nature. In the case reported here a 72-year-old male who was found to have an infective endocarditis complicated by right AAF and AVF. This case illustrates the important role of transesophageal echocardiography in the evaluation of a patient with subacute infective endocarditis with a very rare complication.

Learning points: Aortic fistulas are a rare, potentially fatal, complications of subacute infective endocarditis.Early recognition is greatly assisted by transesophageal echocardiography.