Author + information
- Received October 22, 2011
- Accepted November 14, 2011
- Published online June 1, 2012.
- Rodrigo Estévez-Loureiro, MD⁎ (, )
- Jorge Salgado Fernández, MD,
- Nicolás Vázquez-González, MD,
- Miriam Piñeiro-Portela, MD,
- Ángela López-Sainz, MD,
- Alberto Bouzas-Mosquera, MD,
- Francisco Pombo, MD and
- Alfonso Castro-Beiras, PhD
- ↵⁎Reprint requests and correspondence
: Dr. Rodrigo Estévez-Loureiro, Interventional Cardiology Unit, Division of Cardiology, Complejo Hospitalario Universitario A Coruña, Xubias de Arriba 84, 15006 La Coruña, Spain
A 44-year-old man was referred to the cardiology outpatient clinic due to dyspnea on exertion. He had undergone aortic valve replacement with a biological prosthetic valve (Carpentier-Edwards 23 mm, Edwards Lifesciences, Irvine, California) and reconstruction of the mitroaortic junction due to infective endocarditis by Streptococcus viridians, both events in 2004. Transthoracic echocardiogram revealed a mildly dilated left ventricle with preserved function, a biological prosthetic valve with mild stenosis (effective area 1.3 mm2), and an abnormal flow in the left atrium (Fig. 1A). A transesophageal echocardiogram confirmed a patent communication between the aortic root at the level of the noncoronary sinus and left atrium, close to the anterior mitral leaflet, with preserved prosthetic function (Fig. 1B, Online Video 1). A 64-multislice computed tomography scan demonstrated the defect and allowed the measurement of both long- and short-axis diameters (Figs. 2A and 2B). Angiographic evaluation showed normal coronary arteries, and a multipurpose diagnostic catheter could be placed through the defect (Fig. 1C), allowing the injection of contrast into the atrium (Online Video 2).
Using a right femoral approach, interventional cardiologists were able to cross the defect and deployed 2 Amplatzer Vascular Plug III occluders (AGA Medical Corp., Plymouth, Minnesota) (Figs. 3A and 3B). Monitorization with real-time 3D transesophageal echocardiography showed a marked decrease in the shunt magnitude and that both devices did not interfere with the mitral valve or aortic prosthetic valve function (Figs. 3C and 3D, Online Video 3).
Fistulas between the aorta and cardiac cavities after infective endocarditis are rare. These aortocavitary communications create intracardiac shunts, which may result in clinical deterioration (1,2). Although surgery is the treatment of choice, such a therapeutic option may cause serious complications, and the mortality could be high (3). Percutaneous treatment represents an attractive alternative, and the improvement of recent occlusion devices has placed this technique in the frontline for the treatment of these defects (4).
For accompanying videos, please see the online version of this article.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 22, 2011.
- Accepted November 14, 2011.
- American College of Cardiology Foundation