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DISCUSSION: Risk factors for ACF are presence of a prosthetic valve, valvular regurgitation, and paravalvular abscess. Injection drug use and aortic valve involvement are independent risk factors for paravalvular abscess formation which is more common in prosthetic compared to native valve endocarditis. The most common organism implicated is staphylococcus in 58% of cases, followed by streptococci, and enterococci. Prosthetic valve endocarditis (PVE) post-TAVR has an incidence of 0.3%–1.2% per patient-year. A literature review revealed several articles with streptococcus spp. causing fistulizing disease which is likely related to its unique framework. In a study on animal infective endocarditis, it was discovered that Streptococcus infantarius could stick to various extracellular matrix components such as collagen IV, laminin, fibronectin, and hyaluronic acid. The bacteria were also capable of entering cell lines …