• M Ribas Garau, G J Pons Lladó, J F Forteza Albertí, A Berna Martínez, A Merino Otermín, J O Bonnín Gubianas, and R Barril Baixeras.
• Servicio de Cardiología, Clínica Femenía, Palma de Mallorca.
• Rev Esp Cardiol. 1999 Feb 1;52(2):145-7.

AbstractThe case of a patient with mitral and aortic mechanical valve prostheses is presented who developed early postoperative infective endocarditis and, subsequently, a fistulous communication between the posterior aortic sinus and both the left atrium and the left ventricle. A diastolic murmur of apparent aortic prosthesis regurgitation was heard, although an abnormal aortic valve function could not be demonstrated in the transthoracic echocardiographic study. Instead, the presence of a systolic high velocity flow by continuous wave Doppler suggested prosthetic mitral leakage. The clinical presentation of progressive congestive heart failure and pulmonary hypertension by Doppler prompted a further study by means of transesophageal echocardiography with multiplanar probe showing the above mentioned double fistulous communication. The diagnosis was later confirmed by angiography and also at surgery.

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