Percutaneous closure of an aorto-atrial fistula after surgery for infective endocarditis.

A Co ine Vid A 44-year-old man was referred to the cardiology outpatient clinic due to dyspnea on exertion. He had undergone aortic valve replacement with a biological prosthetic valve (Carpentier-Edwards 23 mm, Edwards Lifesciences, Irvine, California) and reconstruction of the mitroaortic junction due to infective endocarditis by Streptococcus viridians, both events in 2004. Transthoracic echocardiogram revealed a mildly dilated left ventricle with preserved function, a biological prosthetic valve with mild stenosis (effective area 1.3 mm), and an abnormal flow in the left atrium (Fig. 1A). A transesophageal echocardiogram confirmed a patent communication between the aortic root at the level of the noncoronary sinus and left atrium, close