Double fistulous communication between the aorta and both left heart chambers. Diagnosis by multiplanar transesophageal echocardiography

The case of a patient with mitral and aortic mechanical valve prostheses is presented who developed early postoperative infective endocarditis and, su bsequently, a fistulous communication between the posterior aortic sinus an d both the left atrium and the left ventricle. A diastolic murmur of apparent aortic prosthesis regurgitation was heard, a lthough an abnormal aortic valve function could not be demonstrated in the trasthoracic echocardiographic study. Instead, the presence of a systolic h igh velocity now by continuous wave Doppler suggested prosthetic mitral lea kage. The clinical presentation of progressive congestive heart failure and pulmonary hypertension by Doppler prompted a further study by means of tra nsesophageal echocardiography with multiplanar probe showing the above ment ioned double fistulous communication. The diagnosis was later confirmed by angiography and also at surgery.