A rare complication of aortic valve replacement surgery- aorta-right ventricular fistula: an evaluation with real-time multiplane echocardiography.

A 56year-old woman was admitted to our department with severe calcific aortic stenosis of 80/41 mmHg peak/mean pressure gradient and left ventricular dysfunction with an ejection fraction (LVEF) of 25%. After appropriate medical therapy, the patient was referred to department of cardiovascular surgery and an aortic valve replacement surgery was applied with a 21 mm St. Jude Medical mechanical prosthetic valve. A permanent pacemaker was implanted because of complete heart block developed soon after the surgery. After 2 months from surgery, a control echocardiogram demonstrated that left ventricular dysfunction improved markedly (LVEF -55%) and 34/17 mmHg peak/mean pressure gradient of the prosthesis was measured. These results were expected echocardiographic signs. However, with a modified long-axis view of the left ventricular outflow tract, a high-velocity