English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools annual

Global: Zendy Free Plan

Global: Zendy Tools monthly

Global: Zendy Plus monthly

A 39-year-old man with a history of aortic valve replacement 12 years ago and 2 surgical operations for the repair of aortic paravalvular leakage 4 years and 2 years earlier was referred to our echocardiography laboratory for further evaluation of the paravalvular leakage. He complained of dyspnea on exertion (New York Heart Association functional class II). Transthoracic echocardiography revealed severe left ventricular enlargement with mild systolic dysfunction (ejection fraction: 48%), a mechanical bileaflet prosthetic aortic valve with normal leaflet motion, and severe paravalvular leakage from from the anteromedial region of aortic valve sewing ring. Transesophageal echocardiography demonstrated a paravalvular leak and continuous flow between the noncoronary sinus of the aorta and the right atrium, suggestive of a fistula between these 2 chambers. The initial aortic root injection (in the left anterior oblique view) (Fig. A, Video 1) appeared to support the presence of this fistula; however, the selective right coronary injection revealed (Fig. B) that the fistula was between one of the branches of the right coronary artery and the right atrium (Fig. C). Attempts to close the paravalvular leakage site with a device proved unsuccessful, so the patient was referred for surgical repair of the leak. A review of the patient’s signs, symptoms, and medical documents during these years was not indicative of infectious endocarditis, and the significant paravalvular leakage was detected in the early postoperative period. In addition to the congenital cause, repeated surgery may have been a possible cause. It appears that in the evaluation of a patient with a fistula between the cardiac chambers, multimodality imaging may be integral to a meticulous assessment of the patient and may modify the cardiologist’s decisionmaking process. 418

A Right Coronary Fistula Simulating a Connection Between the Right Atrium and the Aorta in a Patient With an Aortic Paravalvular Leakage