Systematic Reviews
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Aug 26, 2016; 8(8): 488-495
Published online Aug 26, 2016. doi: 10.4330/wjc.v8.i8.488
Acquired aortocameral fistula occurring late after infective endocarditis: An emblematic case and review of 38 reported cases
Salah A M Said, Massimo A Mariani
Salah A M Said, Department of Cardiology, Hospital Group Twente, 7555 DL Hengelo, The Netherlands
Massimo A Mariani, Thorax Centre, Department of Cardiac Surgery, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
Author contributions: Said SAM and Mariani MA contributed equally to the manuscript.
Conflict-of-interest statement: Authors have no conflict of interest in connection with the submitted manuscript.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at salah.said@gmail.com. Informed consent, verbal, was obtained for data sharing but the presented data are anonymized and risk of identification is negligible.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Salah AM Said, MD, PhD, FESC, Department of Cardiology, Hospital Group Twente, Geerdinksweg 141, 7555 DL Hengelo, The Netherlands. salah.said@gmail.com
Telephone: +31-88-7085286 Fax: +31-88-7085289
Received: February 13, 2016
Peer-review started: February 16, 2016
First decision: April 15, 2016
Revised: May 5, 2016
Accepted: June 27, 2016
Article in press: June 29, 2016
Published online: August 26, 2016
Processing time: 190 Days and 21 Hours
Abstract
AIM

To delineate the features and current therapeutic option of congenital and acquired aortocameral fistulas (ACF) secondary to iatrogenic or infectious disorders.

METHODS

From a PubMed search using the term "aortocameral fistula", 30 suitable papers for the current review were retrieved. Reviews, case series and case reports published in English were considered. Abstracts and reports from scientific meetings were not included. A total of 38 reviewed subjects were collected and analyzed. In addition, another case - an adult male who presented with ACF between commissures of the right and non-coronary sinuses and right atrium as a late complication of Staphylococcus aureus infective endocarditis of the AV - is added, the world literature is briefly reviewed.

RESULTS

A total of thirty-eight subjects producing 39 fistulas were reviewed, analyzed and stratified into either congenital (47%) or acquired (53%) according to their etiology. Of all subjects, 11% were asymptomatic and 89% were symptomatic with dyspnea (21 ×) as the most common presentation. Diagnosis was established by a multidiagnostic approach in 23 (60%), single method in 14 (37%) (echocardiography in 12 and catheterization in 2), and at autopsy in 2 (3%) of the subjects. Treatment options included percutaneous transcatheter closure in 12 (30%) with the deployment of the Amplatzer duct or septal occluder and Gianturco coil and surgical correction in 24 (63%).

CONCLUSION

Acquired ACF is an infrequent entity which may occur late after an episode of endocarditis of the native AV. The management of ACF is generally by surgical correction but non-surgical device intervention has recently been introduced as a safe alternative.

Keywords: Aortic-atrial shunt; Aortic-atrial fistulas; Infective endocarditis; Late complication; Surgical correction

Core tip: Aortocameral fistula is an uncommon complication of native aortic valve (AV) endocarditis, which is associated with high morbidity and mortality. Acquired aortocameral fistulas (ACF) may originate from any of the three sinuses of Valsalva. Audible continuous murmur may raise suspicion for the presence of ACF. Congenital fistulas are less commonly reported than the acquired types. Acquired ACF may occur late after an episode of endocarditis of the native AV. The management of ACF is generally by surgical correction but non-surgical device intervention has recently been introduced as a safe alternative. Another case is added and the world literature is briefly reviewed.