Abstract 14460: Aortic Valve Infective Endocarditis Complicated by Complete Heart Block and Gerbode’s Defect

Abstract

Introduction: Aortic root abscess with complete heart block is a rare complication of infective endocarditis (IE). Early diagnosis and prompt surgical management are necessary to prevent fatal outcomes. Case Presentation: A 45-year-old male with past medical history of uncontrolled diabetes mellitus was referred to our cardiac intensive care unit for management of complete heart block. His symptoms including exertional dyspnea, hiccups, and dry cough started two weeks prior to presentation. The patient was bradycardic, hypoxic, and hypotensive on examination. Labs were significant for marked leukocytosis 21,000/ul with a neutrophilic predominance. Blood cultures were obtained, and the patient was started on empiric antibiotics vancomycin and piperacillin-tazobactam. Electrocardiogram (ECG) showed evidence of complete heart block and a temporary transvenous pacemaker was placed. A transthoracic echocardiogram was obtained that showed evidence of severe aortic regurgitation and aortic valve vegetations. Due to high clinical suspicion, a transesophageal echocardiogram was immediately performed that revealed aortic root abscess. Patient underwent successful debridement of aortic valve vegetations and aortic valve replacement. Intraoperative findings also included a subaortic left ventricular to right atrial (LV-RA) shunt also known as Gerbode’s defect that was repaired with pericardial patch. Blood cultures and intraoperative tissue cultures confirmed a Staphylococcus lugdunensis infection. He received six weeks of intravenous antibiotics. At 2-month follow-up, the patient reported doing well. Conclusion: New complete heart block may be a manifestation of aortic root abscess. This case illustrates the need to maintain a high level of suspicion for complicated infective endocarditis in patients with sepsis and complete heart block. Timely diagnosis with imaging and early surgical repair results in favorable outcomes.