A fistula between the aorta and left atrium is rare and can cause progressive heart failure.
(1) It is usually preceded by endocarditis involving the aortic valve with paravalvular abscess.
(2) It is associated with acute heart failure that is refractory to routine therapy.
(3) It is often best seen using transesophageal echocardiography. An anterior abscess associated with a prosthetic aortic valve may be seen better using the transthoracic approach.
(4) It is potentially reversible if surgery is performed quickly and fatal if it is not.
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