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Aorto-left atrial fistula in native aortic valve endocarditis secondary to Streptococcus mitis

Wen Qian Zheng, Muhammed Saad Shaukat, Hiren Patel & Mikhail Torosoff

Aorto-cavitary fistulas are rare and serious complications of infectious endocarditis. We present a case of a patient with native bicuspid aortic valve endocarditis secondary to Streptococcus mitis. Intra-operative transesophageal echocardiogram revealed a hemodynamically significant shunt between the aortic root and left atrium via the mitral-aortic inter-vascular fibrosa. Despite initially doing well after aortic valve replacement and fistula repair, he presented back 3 weeks later and rapidly decompensated, eventually succumbing to cardiac arrest. Such cases are often associated with higher rates of acute heart failure and post-operative mortality remains high.