Aorto-right ventricular fistula - A late complication of aortic valve replacement

We report the case of a patient who was found to have an aorto-right ventri cular fistula 17 years after receiving a Bjork-Shiley prosthetic aortic val ve. A pseudoaneurysm had formed at the aortotomy suture line, and it had ex tended into the interventricular septum and had eventually opened into the right ventricle. Using transesophageal echocardiography, we identified the defect in the ascending aorta, and a left-to-right shunt. Aortography was u sed to confirm these findings. The pseudoaneurysm was successfully resected and the ascending aorta was replaced with a Dacron graft. To the best of o ur knowledge, no similar late complication of aortic valve replacement has been reported in the medical literature.