Left ventricular outflow track to left atrium fistula: a complication of enterococcal endocarditis and long-term outcome

We describe a rare complication of <i>Enterococcus faecalis</i> infective aortic valve endocarditis with flail and perforated aortic valve leaflets causing torrential regurgitation, followed by secondary infection of the sub and supra-aortic structures causing cystic abscess of mitral aortic intervalvular fibrosa and pseudoaneurysm of the aorta. The mitral valve cystic abscess ruptured and caused a fistulous connection between the left ventricular outflow tract and the left atrium. The patient underwent surgical replacement of the aortic valve, repair of the mitral aortic fibrosa and repair of the aortic pseudoaneurysm. The persistent mitral valve fistula was treated with a conservative approach.