Abstract
Infectious endocarditis (IE) with acute heart failure is a medical emergency. In particular, postoperative IE after aortic repair with an artificial vascular graft is a life-threatening matter. We present a case in which a mobile abscess appeared on the aortic valve annulus with an intra-cardiac shunt in the left ventricle (LV) to the right atrium (RA) after ascending aortic repair with aortic valve replacement (AVR) for acute type A aortic dissection. It was diagnosed with transesophageal echocardiography (TEE), which prompted further exploration.
Highlights
Intra-cardiac shunts in the left ventricle (LV) to the right atrium (RA) are mostly congenital [1]
Intra-cardiac shunts with periannular abscesses related to infectious endocarditis (IE) have been reported in 14 % of patients after prosthetic valve replacement [2]
We present a case in which a mobile abscess appeared on the aortic valve annulus with an intra-cardiac shunt in the LV to the RA after ascending aortic repair with aortic valve replacement (AVR) for acute type A aortic dissection
Summary
Intra-cardiac shunts in the left ventricle (LV) to the right atrium (RA) are mostly congenital [1]. We present a case in which a mobile abscess appeared on the aortic valve annulus with an intra-cardiac shunt in the LV to the RA after ascending aortic repair with aortic valve replacement (AVR) for acute type A aortic dissection. It was diagnosed with transesophageal echocardiography (TEE), which prompted further exploration. The color Doppler TEE from the modified five-chamber view showed an intra-cardiac shunt from the LV to the RA through a subaortic ventricular septal fistula (Fig. 4). In spite of all our medical efforts, on 30 POD, the patient died of multiple organ failure due to IE at the hospital
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