An Occult Aortocavitary Fistula Presenting as Apparent Tricuspid Valve and Aortic Valve Endocarditis

摘要

class="kwd-title">Keywords: Endocarditis, Aortocavitary fistula, Periannular complications, Transesophageal echocardiography class="head no_bottom_margin" id="sec1title">IntroductionInfective endocarditis (IE) is a potentially lethal infection with an annual incidence of three to nine cases per 100,000 persons. Patients who are at increased risk include those with prosthetic valves, prior IE, unrepaired congenital heart disease, diabetes mellitus, human immunodeficiency virus infection, and/or intravenous drug abuse. Some of these risk factors can certainly raise the propensity for vegetations to develop on a particular valve. For example, intravenous drug abuse and/or cardiac implanted devices can increase the incidence of right-sided endocarditis, which represents approximately 5% to 10% of all cases of IE. Overall, single-valve involvement accounts for the majority of cases (about 78%), whereas multivalve involvement is much less common (about 17%–19%)., Complications from the disease can be significant and include valvular destruction, congestive heart failure, stroke and systemic embolizations, conduction abnormalities, and bacteremia. Rarely, perivalvular structures can be involved, leading to abscess formation, valve disruption, and in some cases more serious complications. We present a case in which IE conferred significant morbidity to a patient as a result of an aortocavitary fistula, which is an anomalous connection from the aorta to a cardiac chamber.