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Concealed Left Ventricle to Right Atrium Fistula Complicating Infective Endocarditis  Tatsushi Onzuka, MD, PhD, Shoji Morishige, MD, Yoshiyuki Yamashita,

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Presentation on theme: "Concealed Left Ventricle to Right Atrium Fistula Complicating Infective Endocarditis  Tatsushi Onzuka, MD, PhD, Shoji Morishige, MD, Yoshiyuki Yamashita,"— Presentation transcript:

1 Concealed Left Ventricle to Right Atrium Fistula Complicating Infective Endocarditis 
Tatsushi Onzuka, MD, PhD, Shoji Morishige, MD, Yoshiyuki Yamashita, MD, Yasutaka Ueno, MD  The Annals of Thoracic Surgery  Volume 102, Issue 3, Pages e249-e251 (September 2016) DOI: /j.athoracsur Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

2 Fig 1 Four-chamber echocardiographic view showing (A) two independent vegetations (dotted circles), one below the SJM aortic valve and the other attached to the atrioventricular septum. (B) Color Doppler assessment showing no evidence of aortic regurgitation related to perivalvular leakage or left-to-right shunt across the atrioventricular septum. (AML = anterior mitral leaflet; AVMS = atrioventricular membranous septum; LA = left atrium; LV = left ventricle; RA = right atrium; RV = right ventricle; SL = septal leaflet of tricuspid valve.) The Annals of Thoracic Surgery  , e249-e251DOI: ( /j.athoracsur ) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

3 Fig 2 Operative findings through right atrium. (A) Arrows show vegetations attached to RA wall above the atrioventricular membranous septum. (B) LV–RA fistula found after removal of the vegetations. Green surgical sutures of the sewing ring of the SJM aortic valve are visible. Dotted lines indicate the tricuspid annulus; dotted circle indicates atrioventricular membranous septum; blue asterisk indicates atrioventricular node. (AVMS = atrioventricular membranous septum; CS = coronary sinus; FO = fossa ovalis; RA = right atrium; SVC = superior vena cava.) The Annals of Thoracic Surgery  , e249-e251DOI: ( /j.athoracsur ) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

4 Fig 3 Operative findings through aortotomy. (A) After removal of the SJM aortic valve. There are abundant vegetations (arrows) below the aortic annulus. (B) The left coronary annulus has dropped toward the aortic-mitral curtain. Dotted line indicates the suture line of the SJM aortic valve. Metzenbaum scissors have been inserted into the LV–RV fistula. (LCA = left coronary annulus; L-N = left noncoronary commissure; L-R = left right coronary commissure; R-N = right noncoronary commissure; RA = right atrium; SVC = superior vena cava.) The Annals of Thoracic Surgery  , e249-e251DOI: ( /j.athoracsur ) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

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