Multimodality imaging of the mitral paravalvular abscess cavity with left ventriculo-atrial fistula.

Paravalvular complications may occur in patients with infective endocarditis. Paravalvular abscess formation rarely occurs and if so it generally involves the aortic valve. Herein we present a case of left ventriculo-atrial fistula formation through mitral paravalvular abscess cavity shown by multimodality imaging including two- and real-time three-dimensional transoesophageal echocardiography (RT 3-D TEE), cardiac magnetic resonance imaging (CMRI), multislice computed tomography (MSCT) and ventriculography in a patient with a mechanical prosthetic mitral valve. This is the first case in the literature of a mechanical prosthetic mitral valve complicated by a left ventriculo-atrial fistula formation in a healed abscess cavity that is demonstrated with RT-3D TEE, cardiac MRI and MSCT.