Subaortic-Right Atrial Fistula after Endocarditis in Hypertrophic Cardiomyopathy.
Infective endocarditis in hypertrophic obstructive cardiomyopathy is rare. Management of this disease is challenging due to the unique features of dynamic pressure gradient over the left ventricular outflow tract and its unpredictable interaction with the management of sepsis. The added complexity of infective endocarditis further complicates an already difficult situation. A 72-year-old man with hypertrophic obstructive cardiomyopathy presented with acute stroke, fever, and Staphylococcus aureus bacteremia. Infective endocarditis of the aortic valve was confirmed. Despite treatment with antibiotics and aortic valve replacement, the patient had recurrent bacteremia and developed a periannular abscess and a subaortic-right atrial fistula, with a resulting fatal outcome.


BACKGROUND
Aortic valve replacement; Endocarditis; Hypertrophic obstructive cardiomyopathy; Subaortic-right atrial fistula.
Division of Cardiology, Department of Internal Medicine, Chung Shan Medical University Hospital; ; Institute of Medicine, Chung Shan Medical University.
Sung-Kien
SK
Sia
Division of Cardiovascular Surgery, Department of Surgery, Chung Shan Medical University Hospital; ; School of Medicine, Chung Shan Medical University;
Yi-Liang
YL
Wu
Division of Cardiology, Department of Internal Medicine, Chung Shan Medical University Hospital; ; School of Medicine, Chung Shan Medical University;
Der-Jinn
DJ
Wu
Division of Cardiology, Department of Internal Medicine, Chung Shan Medical University Hospital; ; School of Medicine, Chung Shan Medical University;
Ming-Cheng
MC
Lin
Division of Cardiology, Department of Internal Medicine, Chung Shan Medical University Hospital; ; School of Medicine, Chung Shan Medical University;
Kwo-Chang
KC
Ueng