Aortic Root Abscess With Fistula Formation into Right Ventricular Myocardium

A fistula between aorta and right ventricular outflow tract is one of the uncommon complications of periannular abscess, which develops after aortic valve endocarditis. Operation for infective aortic valve endocarditis with associated periannular abscess has high mortality and morbidity rates. After 2-month- long antibiotic therapy for infective aortic valve endocarditis, a 34-year-old man underwent operation for severe aortic valve stenosis and insufficiency with associated aortico-right ventricular myocardial fistula in 1999. Reconstruction of the aortic wall and the right ventricular outflow tract was performed by primary closure of these defects following radical resection of the abscess cavity. Aortic valve replacement was applied with 23 mm St. Jude mechanical, bileaflet prosthetic valve. Postoperative course was uneventful, and he remained asymptomatic during follow-up controls. Because it is the most serious complication, when a fistula is diagnosed after active infective aortic valve endocarditis, surgical repair should be performed.