Acquired Aorto-Atrial Fistula from Intravenous Drug Use with Underlying Congenital Heart Disease.

The development of an aorta-atrial fistula secondary to mechanical aortic valve infective endocarditis is a rare, serious complication. The fistula is an aberrant intra-cardiac shunt that occurs between the aorta and either the left or right atrium. An aorta-atrial fistula can be congenital or acquired. In the case of infective endocarditis, the infection’s expansion beyond the valvular structure may result in an aorto-cavitary fistula (ACF or AAF) with an estimated incidence of 1-2%. No clinical trials have been conducted for the best approach of management for this condition. Therefore, treatment strategies are applied on a case-by-case basis by expert opinion. Patients develop symptoms of heart failure secondary to AAF complications. The underlying cause of AAF needs to be identified with the use of imaging studies to determine the approach of optimal treatment. We are reporting a case of a 32-year-old male with a history of repaired congenital heart disease, who developed mechanical aortic valve infective endocarditis from intravenous drug use with subsequent development of an aorta-atrial fistula.