Echocardiography to diagnose an evolving Sinus of Valsalva fistula from infective endocarditis

Abstract Sinus of Valsalva (SOV) fistulas are rare entities and have been infrequently described after episodes of aortic valve (AV) infective endocarditis (IE). Patients with SOV fistulas or ruptured SOV aneurysms can present with varying symptoms and physical exams. Identification of SOV fistulas is crucial, with frequent need for surgical intervention due to risk of congestive heart failure or cardiogenic shock. We present a case of a SOV-to-right atrial (RA) fistula from AV IE that was diagnosed by intraoperative transesophageal echocardiography (TEE). Management included AV replacement (AVR) and aortic root debridement, tricuspid valve annular debridement and annuloplasty, and closure of the fistula tract using a pericardial patch.