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Transthoracic echocardiography. Color Doppler revealed the newly detected aorto-right atrial shunt (arrow).
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Transthoracic echocardiography (TTE) showed hyperdynamic biventricular function and shunting from the aortic root to the right atrium (Fig. 1).
CT-scan of the heart showing fistula between LVOT and right atrium (arrow).
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Position, dimension and exact anatomic conditions of the fistula were obtained by contrast enhanced computed tomography (Fig. 2).
Intraoperative view into the aortic root after explantation of the infected bioprosthesis. Cardiotomy of the right atrium allowed for exact detection of the perforated root abscess.
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After removal of the bioprosthesis, a large periannular abscess opening into the right atrium was uncovered (Fig. 3).