Aorto-right ventricular fistula: An early complication of aortic valve replacement

Abstract

The implantation of prosthetic heart valves has been associated with several kinds of complications, but the description of aorto-right ventricle (ARV) fistula as a complication of aortic valve replacement is a very rare finding. We report herein the case of a 56-year-old woman sought care for palpitations two months after prosthetic aortic and mitral valve replacement. Cardiac examination revealed normally audible mechanical sounds with a new loud to-and-fro murmur with continuous precordial thrill. Thyroid function tests were poorly balanced (raised FT4 and lowered TSH). Electrocardiography at admission displayed rapid heart rhythm with atrial fibrillation. Trans-thoracic echocardiography (TTE) revealed left-to-right shunt due to aorto-RV fistula. We discuss then the aetiology, diagnosis and management of this rare para-valvular leakage.