Left ventricular outflow tract to left atrial fistula: A rare long-term complication of the commando procedure

The commando procedure involves aortic and mitral valve replacement with complete reconstruction of the aorto-mitral curtain. It is often a surgical treatment for invasive infective endocarditis with abscess, or less commonly for radiation-induced heart disease with extensive calcification extending from the aortic valve onto the anterior mitral leaflet. Prosthetic valve endocarditis is a known long-term complication of this surgery; however, reports of other long-term outcomes are limited. We report the case of a 59-year-old male who developed a non-infectious left ventricular outflow tract to left atrial fistula, incidentally found 5 years after undergoing a commando procedure for radiation-induced heart disease.