Extract

A 51-year-old man was referred to our institution for NYHA functional class II dyspnoea. His medical history had no chest trauma or chest pain, but was significant for a continuous cardiac murmur known since his childhood but never explored. He had no fever and biological disorder.

An echocardiography showed a large communication between the right valsalva sinus of the aortic root and the right ventricle (RV) outflow tract with significant left-to-right shunt (Panel A). The RV and pulmonary artery were moderately dilated, left ventricular ejection fraction was normal, and aortic and pulmonary valves were tricuspid with no valvular disease. There were no other cardiac defects. Cardiac catheterization showed no evidence of pulmonary hypertension, coronary angiography revealed any coronary disease, and aortography showed the shunt to the RV (Panel B). Chest-computed tomography scans confirmed the isolated aorto-right ventricular fistula (Panel C) with normal sizes of aortic root and ascending aorta. Because of right cavities dilation with dyspnoea, the patient had been successfully operated on for fistula (Panel D) closure.

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