Acquired aortocameral fistula occurring late after infective endocarditis: An emblematic case and review of 38 reported cases

Table 1 Clinical presentations and management of 39 subjects

Ref.	Age gender	ACF	Diagnostic modality	Clinical presentation/etiology	Management
Jung et al[19], 2011	49 M	NCS-right atrium	TTE	Dyspnea and high fever Ruptured sinus of Valsalva Infective endocarditis (Enterococcus gallinarum)	Patch repair AVR/TVR
Raufi et al[21], 2002	50 M	RCS-right atrium	TEE aortography cardiac cath	Dyspnea and chest pain Post-repair of aneurysm of right sinus of Valsalva	Repair of the ruptured sinus of Valsalva Closure of the fistula
Hsu et al[2], 2000	67 M	False lumen-Right atrium	TTE cardiac cath ioTEE	Dyspnea Acute aortic dissection	Fistula repair Bentall procedure
Chung et al[20], 2000	52 M	AAR-right atrium	TTE cardiac cath angiography MRI	Dyspnea and hemoptysis Post-repair (ARR) of acute aortic dissection	Closure of the fistula New composite aortic root graft
Ananthasubramaniam et al[24], 2005	66 M	LCS-left atrium	TTE TEE ioTEE	Dyspnea post-AVR	Surgical closure of the fistula/repair
Haddad et al[22], 2008	66 M	NCS-right atrium	TTE	Dyspnea post-repair of acute aortic dissection	Fistula repair Bentall procedure
Estévez-Loureiro et al[5], 2012	44 M	NCS-left atrium	TTE TEE MDCT CAG 3-D TEE	Dyspnea Infective endocarditis post-AVR (Streptococcus viridans)	Percutaneous Amplatzer vascular plug III occluder
Bouchez et al[13], 2012	61 M	LCS-left atrium	io TEE 3-D TEE	Asymptomatic	Conservative
Mundo-Sagardía et al[14], 2006	22 M	NCS-right atrium	TTE TEE	Infective endocarditis (Streptococcus mitis). Complex congenital heart disease. Perforation of sinus Valsalva aneurysm (NCS)	Closure/repair
Ladowski et al[4], 1984	56 F	NCS-right atrium	angiography	Iatrogenic dissection	Surgical closure/repair
Vydt et al[36], 2002	43 M	NCS-right atrium	TTE TEE cardiac cath angiography aortography	Chest pain, DOE, ruptured sinus Valsalva aneurysm	Surgical closure
Moiduddin et al[12], 2009	5 F	NCS-left atrium	TEE angiography cardiac cath	Amplatzer atrial septal occluder ASD PDA	Surgical closure/repair
Chandra et al[1], 2011	12 F	RCS-right atrium	TTE CTA aortography angiography cardiac cath	Dyspnea, palpitation	Percutaneous Amplatzer duct occluder
Noureddine et al[16], 2001	21 F	NCS-right atrium	TTE TEE	Dyspnea	Sudden death
Przybojewski et al[39], 1983	27 M	RCS/right atrium and right ventricle	Phonocardiography TTE cardiac cath angiography aortography	Dyspnea; biventricular heart failure, ruptured sinus Valsalva aneurysm (RCS)	Surgical closure/repair
Mujanovic et al[35], 2010	41 F	NCS-right atrium	TTE angiography	Heart failure; ruptured sinus Valsalva aneurysm (NCS)	Surgical closure/repair
Mello et al[33], 2005	16 F	NCS-left atrium	TTE TEE aortography	Asymptomatic, post-placement of Amplatzer atrial septal occluder (ASO) for ASDII	Surgical closure/repair
Grayburn et al[7], 2005	41 F	Aorta-right atrium	TTE TEE	Chest pain, post-placement of Amplatzer atrial septal occluder (ASO) for ASD	Surgical closure/repair
Chun et al[30], 2003	10 M	NCS-right atrium	TTE TEE	Asymptomatic, post-placement of Amplatzer atrial septal occluder (ASO) for ASD	Surgical closure/repair
Knirsch et al[32], 2005	3 M	NCS-left atrium	TTE	Asymptomatic, post-placement of Amplatzer atrial septal occluder (ASO) for ASD	Surgical closure/repair
Jang et al[31], 2005	54 F	NCS-right atrium	TTE	Dyspnea, palpitation, hematuria, post-placement of Amplatzer atrial septal occluder (ASO) for ASDII	Surgical closure/repair
Ozay et al[45], 2007	22 F	NCS-right atrium	TTE TEE aortography cardiac catheter	Palpitation post-surgical repair of VSD and ASDII	Surgical closure/repair/ correction
Elwatidy et al[46], 2003	3 F	Aortic isthmus-RA	TTE cardiac catheter	Presented as a case of PDA	Surgical closure/repair/ correction
Akowuah et al[10], 2002	52 F	NCS-right atrium	TTE cardiac catheter	CHF, IE, TV, Staphylococcus aureus MRSA	Surgical TVR correction
Darwzah et al[15], 2006	23 M	NCS/LCS-right atrium	TTE	PVE of AVR Staphylococcus epidermidis	Surgical Re-re AVR correction
Russo et al[47], 2001	70 F	NCS-right atrium	TTE TEE	Chest pain, dyspnea, CHF complication of AAD type 1	Surgical closure/repair/ correction
Onorato et al[9], 2005	48 F	NCS-right atrium	TTE TEE ICE aortography cardiac catheter	Dyspnea, CHF, ruptured sinus Valsalva aneurysm	ADO catheter closure
Chang et al[8], 2006	47, 22 F (2 ×) and 22,18M (2 ×)	NCS-RA (1 ×) RCS-RA (1 ×) and RCS-RV (2 ×)	4 × TEE 4 × aortography	Closure of VSD and AVR, IE (1 ×) Dyspnea and palpitation (3 ×)	ADO catheter closure (3 ×) and Gianturco coil (1 ×)
Szkutnik et al[6], 2009 congenital (4 ×) and acquired (1 ×)	51, 23, 41 M (3 ×) and 18, 28 F (2 ×)	RCS-RVOT (3 ×), RCS-RA (1 ×) LCS-PA (1 ×) and NCS-RA (1 ×)	TTE TEE MDCT	Dyspnea, chest pain, palpitation and syncope	ADO (5 ×) and ASO (1 ×) catheter closure
Oram et al[17], 1955	36, 67 M (2 ×)	NCS-RA RCS-RA, RV	Catheterization, autopsy	Chest pain, palpitation, dyspnea Chest pain, dyspnea	Post-mortem
Said and Mariani 2016	44 M	NCS-RCS-RA	TTE, aortography cardiac cath, angiography	Easy fatigability	Surgical closure

AAD: Acute aortic dissection; ACF: Aortocameral fistula; AAR: Aneurysm of the aortic root; ADO: Amplatzer duct occlude; ARR: Aortic root replacement; ASD: Atrial septal defect; ASO: Amplatzer atrial septal occlude; AVR: Aortic valve replacement; CHF: Congestive heart failure; CP: Chest pain; CTA: Computed tomography angiography; D: Dyspnea; DOE: Dyspnea on exertion; F: Female; ICE: Intra-cardiac echocardiography; IE: Infective endocarditis; io: Intra-operative; LCS: Left coronary sinus; M: Male; MDCT: Multi-detector computed tomography; MRI: Magnetic resonance imaging; NCS: Non-coronary sinus; PA: Pulmonary artery; PDA: Patent ductus arteriosus; PVE: Prosthetic valve endocarditis; RA: Right atrium; RCS: Right coronary sinus; RV: Right ventricle; RVOT: Right ventricular outflow tract; TEE: Transesophageal echocardiography; TTE: Transthoracic echocardiography; TV: Tricuspid valve; TVR: Tricuspid valve replacement; VSD: Ventricular septal defect.

Table 2 Etiology of aortocameral fistulas

Etiology	Condition/references
Congenital	Congenital RCS-RA fistula[1] and aortic isthmus-RA fistula[46]
Acquired-iatrogenic (post-surgical and non-surgical intervention/infectious/diagnostic procedures)	Iatrogenic aorta-right atrial fistula: late (14 years) post-surgical repair of VSD and ASD[45]
	Post-corrective surgery of sinus of Valsalva aneurysm[21]
	Post-CABG[23,48]
	Post-AVR[3,8]
	Post-MVR[23]
	Post-ARR, after operating on a type A dissection[20,47]
	Following ASO closure of the secundum ASDII[30]
	NVE[10], RCS/NCS-right atrial fistula (current case) secondary to NVE
	PVE[5,15]
	ACF associated with diagnostic cardiac catheterization (NCS-RAA)[4]
Acquired-accidental/traumatic	ACF post-non-penetrating thoracic injury[49] has been reported
Spontaneous	RSVA[27]
	Rupture of ascending aorta aneurysm[18]

ACF: Aortocameral fistula; ARR: Aortic root replacement; ASD: Atrial septal defect; ASO: Amplatzer atrial septal occlude; AVR: Aortic valve replacement; CABG: Coronary artery bypass grafting; MVR: Mitral valve replacement; NCS: Non-coronary sinus; NVE: Native valve endocarditis; PVE: Prosthetic valve endocarditis; RA: Right atrium; RAA: Right atrial appendage; RCS: Right coronary sinus; RSVA: Ruptured sinus Valsalva aneurysm; VSD: Ventricular septal defect.