AORTO-LEFT ATRIAL FISTULA - A REVERSIBLE CAUSE OF ACUTE REFRACTORY HEART-FAILURE

Fistulas between the aorta and left atrium, invariably a complication of aortic valvular endocarditis, are rare and infrequently diagnosed p remortem. We describe a patient who presented with this entity and rev iew the reports of five other patients for whom a diagnosis was made p remortem. A number of causative organisms have been identified. The cl inical course is characteristically one of rapidly progressive heart f ailure. Notably, only half of these fistulas were detected by transtho racic echocardiography, whereas all were identified by transesophageal echocardiography when utilized. Once the diagnosis is made, prompt su rgical repair is required to avert the high mortality from rapidly dev eloping refractory congestive heart failure.