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Surgical replacement followed, revealing vegetations and an annular abscess; postoperative TEE suggested a pseudoaneurysm-related fistula to the pulmonary artery. CTA the next day confirmed rapid progression and a newly formed aortic valve–pulmonary trunk fistula. The patient died 3 days later from sepsis and strokes.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/aortopulmonary-fistula-as-a-rare-complication-of-bioprosthetic-aortic-valve-endocarditis-a-case-report/443572/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/aortopulmonary-fistula-as-a-rare-complication-of-bioprosthetic-aortic-valve-endocarditis-a-case-report/443572.png","ImageObject",300,407,{"name":92,"@type":93},"Ophelia","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-03","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":24},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What led to the diagnosis in this case?","Question",{"text":112,"@type":113},"ECG-gated cardiac CT angiography showed prosthetic valve degeneration with hypoattenuated leaflet thickening and a left-cusp pseudoaneurysm, prompting emergent surgical replacement.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How was the suspected fistula evaluated after surgery?",{"text":117,"@type":113},"Post-operative transoesophageal echocardiography detected a pseudoaneurysm of the prosthetic valve and raised suspicion of a fistula to the pulmonary artery.",{"name":119,"@type":110,"acceptedAnswer":120},"What imaging confirmed the final diagnosis and how quickly did it progress?",{"text":121,"@type":113},"CTA performed the following day (14 days after valve replacement) confirmed rapid progression of the pseudoaneurysm and a newly formed fistula between the aortic valve and the pulmonary trunk.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},443572,1790764097,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":24,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":14,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":24},7971461741311,"https://ap-avatar.wpscdn.com/avatar/74000253aff267980c6?x-image-process=image/resize,m_fixed,w_180,h_180&k=1779345379180704826","European Heart Journal-Case Reports (2026) 10, ytaf659 [https://doi.org/10.1093/ehjcr/ytaf659](https://doi.org/10.1093/ehjcr/ytaf659)  \nIMAGES IN CARDIOLOGY  \nValvular heart disease  \nAortopulmonary fistula as a rare complication of bioprosthetic aortic valve endocarditis: a case report  \nThomas Saliba  1*, David Rotzinger1, Mariama Touray2, and Guillaume Fahrni1  \n1Radiology Department, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, Lausanne 1005, Switzerland; and 2Cardiology Department, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, Lausanne 1005, Switzerland  \nReceived 25 August 2025; revised 20 November 2025; accepted 8 December 2025; online publish-ahead-of-print 18 December 2025  \nESC curriculum 2.4 Cardiac computed tomography • 2.2 Echocardiography • 2.1 Imaging modalities • 4.10 Prosthetic valves • 4.11 Endocarditis  \nCase description  \nA 67-year-old man presented for the management of a Staphylococcus lugdunensis bioprosthetic valve endocarditis (PVE) .  \nAn ECG-gated cardiac CT angiography (CTA) revealed prosthetic valve degeneration with hypoattenuated leaflet thickening (HALT), complicated by a pseudoaneurysm of the left cusp (Figure 1A and B), resulting in its emergent surgical replacement.  \nThe surgeons discovered vegetations on both the aortic and ventricular surfaces ofthe prosthetic valve, alongside an annular abscess extending towards the non-coronary commissure, creating a 1-cm cavity between the left and right commissures. The patient underwent debridement of the abscess with resection and repair of the pseudoaneurysm alongside the valvular replacement.  \nA post-operative transoesophageal echocardiogram (TEE) revealed apseudoaneurysm of the prosthetic valve, raising suspicion of a fistula between the pseudoaneurysm and the pulmonary artery (Figure 1C and D) .  \nA cardiac CTA was performed the following day, 14 days after the aortic valve replacement, revealing rapid progression of the pseudoaneurysm of the new prosthetic valve and confirmed the presence of a newly formed fistula between the aortic valve and the pulmonary trunk (Figure 1E and F) .  \nThe patient passed away 3 days later, following complications of sepsis and strokes.  \nAortopulmonary fistula is a rare but life-threatening complication of prosthetic valve endocarditis, associated with high mortality. When PVE occurs, it may lead to the formation of pseudoaneurysms, which are best detected with CTA or TEE.1 If a fistula is suspected, invasive coronary angiography should be avoided due to increased risks of adverse events.2  \nOnce pseudoaneurysms develop, they can be further complicated by the formation of fistulas, which are perforations caused by erosion between two cavities.1 In such cases, TEE is more accurate than CTA due to its superior temporal resolution.1  \n* Corresponding author. Tel: 0795562580, Email: [tes1066@hotmail.com](tes1066@hotmail.com)[ ](tes1066@hotmail.com)Handling Editor: Rita Pavasini  \nPeer-reviewers: Edgar Francisco Carrizales Sepulveda; Eirini Beneki  \n© The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology.  \nThis is an Open Access article distributed under the terms of the Creative Commons Attribution License ([https://creativecommons.org/licenses/by/4.0/](https://creativecommons.org/licenses/by/4.0/)), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.  \nFigure 1 Imaging of prosthetic valve endocarditis complicated by pseudoaneurysm and aortopulmonary fistula. Contrast-enhanced CT scan (CT angiography) (A) and 3D virtual reconstruction (3D VR) (B) showing hypoattenuated leaflet thickening (yellow arrow) and a contained pseudoaneurysm (white arrow) upon admission. Cardiac transoesophageal echocardiogram in B-mode (C ) and Doppler mode (D) of the aortic valve acquired postoperatively, revealing pseudoaneurysm (yellow star) with evidence of fistulization to the pulmona","cbCaih0NfWW1mslz","https://ap.wps.com/l/cbCaih0NfWW1mslz","pdf",272003,"English","# Case description\n# Imaging and diagnosis\n# Clinical course and outcome\n# Key clinical implications","[{\"question\":\"What led to the diagnosis in this case?\",\"answer\":\"ECG-gated cardiac CT angiography showed prosthetic valve degeneration with hypoattenuated leaflet thickening and a left-cusp pseudoaneurysm, prompting emergent surgical replacement.\"},{\"question\":\"How was the suspected fistula evaluated after surgery?\",\"answer\":\"Post-operative transoesophageal echocardiography detected a pseudoaneurysm of the prosthetic valve and raised suspicion of a fistula to the pulmonary artery.\"},{\"question\":\"What imaging confirmed the final diagnosis and how quickly did it progress?\",\"answer\":\"CTA performed the following day (14 days after valve replacement) confirmed rapid progression of the pseudoaneurysm and a newly formed fistula between the aortic valve and the pulmonary trunk.\"}]","Aortopulmonary fistula as a rare complication of bioprosthetic aortic valve endocarditis - a case report | PDF",1790704467]