- Author: Gwan Sic Kim, Do Wan Kim, In Seok Jeong, Byung Hee Ahn, Sang Gi Oh
- Date: 2016/12/31
- Journal: Journal of Cardiac Surgery;31(12);738-739
- PMID: 27813157
- PMCID:
- DOI: 10.1111/jocs.12863
Abstract
A 42-year-old male was admitted with fever, chills, and dyspnea. Physical examination revealed a grade 3/6 continuous murmur over the 2nd and 3rd right anterior interspaces. An electrocardiogram demonstrated atrial fibrillation with a rapid ventricular response. Transesophageal echocardiography identified a tubular structure between the aorta and a dilated right atrium with continuous flow, along with multiple vegetations on the mitral and aortic valves accompanied with severe valvular regurgitation (Figure 1A and B). Blood cultures grew Streptococcus anginosus. At the time of surgery, following cardioplegic arrest with retrograde, cold blood cardioplegia, exploration of the aortic root and right atrium revealed an orifice in the superior aspect of the interatrial septum just below the orifice of the superior vena cava which communicated with an 8-mm orifice below the ostium of the left coronary artery within a dilated left sinus of Valsalva (Figure 2A and B). Both orifices were closed with interrupted 4–0 pledgeted mattress sutures. Vegetations were present on both the aortic and mitral valves (Figure 2C and D) which were replaced with 23- and 29-mm mechanical valves (St. Jude Medical, St Paul, MN, USA), respectively. A modified Cox-maze procedure was performed using a Cryoablator (Surgi Frost, Medtronic, Inc., Minneapolis, MN, USA). The patient tolerated the procedure well and received four weeks of intravenous antibiotics (Ceftriaxone 2 g/day and Gentamicin 3 mg/kg/day). A transthoracic echocardiogram one year following surgery showed normal functioning prostheses and no recurrent aorto-right atrial fistulas (Figure 3).