Chronic Traumatic Aortoventricular Fistula Following a Stab Injury: A Case Report

TL;DR

A 17-year-old woman developed heart complications nine years after a chest injury, requiring surgery to repair a rare abnormal connection between her aorta and heart.

Contribution

This case report highlights the delayed presentation and successful surgical repair of a chronic traumatic aortoventricular fistula.

Findings

Aortoventricular fistula was diagnosed 9 years after a penetrating chest injury using echocardiography and CT.

Surgical repair under cardiopulmonary bypass successfully closed the defect with no residual shunting or valve dysfunction.

The case emphasizes the importance of early detection and timely intervention to prevent long-term complications.

Abstract

An aorto‐cameral fistula (ACF) is a rare abnormal communication between the aorta and a cardiac chamber, often resulting from trauma, ruptured sinus of Valsalva aneurysms, infective endocarditis, aortic dissection, or iatrogenic causes. Clinical presentations vary from asymptomatic cases to severe hemodynamic compromise, including heart failure, arrhythmias, and sudden cardiac death. We present a 17‐year‐old female with exertional dyspnea and fatigue, 9 years after a penetrating chest trauma. Transthoracic echocardiography and cardiac CT revealed an 8 mm fistulous connection between the right sinus of Valsalva and the right ventricular outflow tract. Surgical repair under cardiopulmonary bypass successfully closed the defect with 5‐0 Prolene sutures, confirmed intraoperatively without residual shunting or aortic valve dysfunction. The patient recovered uneventfully and was discharged on postoperative day four. This case highlights the diagnostic challenges of chronic traumatic ACF and emphasizes the importance of multimodal imaging for early detection and timely surgical intervention to prevent long‐term hemodynamic deterioration. Given the potential for delayed complications, clinicians should maintain a high index of suspicion for post‐traumatic cardiac fistulas, even years after the initial injury.

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