SINUS OF VALSALVA (SOV) fistulas are rare entities and have been described infrequently
after episodes of aortic valve (AV) infective endocarditis (IE). Patients with SOV
fistulas or ruptured SOV aneurysms can present with varying symptoms and physical
examination findings. Identification of SOV fistulas is crucial, with frequent need
for surgical intervention due to risk of congestive heart failure or cardiogenic shock.
The authors present a case of a SOV-to-right atrial (RA) fistula from AV IE that was
diagnosed by intraoperative transesophageal echocardiography (TEE). Management included
AV replacement (AVR) and aortic root debridement, tricuspid valve annular debridement
and annuloplasty, and closure of the fistula tract using a pericardial patch. The
trends in the incidence, risk factors, microbiology, and outcomes of IE have been
studied extensively all over the world. A population-based observational study in
France in 2008 reported that the annual incidence of IE was 33.8 cases per million
people.
1
Incidence of IE, however, has been noted to be as high as 15 per 100,000 people,
with overall mortality reported to be between 14% and 46%.
2
,
3
,
4
SOV fistulas have been described infrequently after episodes of bacterial endocarditis;
the incidence of SOV fistula after IE has been estimated to be <1% of all cases of
IE.
5
Key words
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Published online: January 16, 2021
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