Abstract
An annular aortic abscess is a fatal complication of infective endocarditis. Echocardiography is the initial imaging modality to confirm the diagnosis in suspected infective endocarditis. Here, we present a case of a bicuspid aortic valve infective endocarditis caused by Staphylococcus aureus and complicated with annular aortic abscess resulting in acquired Gerbode defect (type II) with tricuspid valve vegetation which was undiagnosed preoperatively. The intraoperative transoesophageal echocardiography yields a new finding prior to the surgical incision, which impacted the clinical decision-making and increased the burden of the procedure.
Highlights
Gerbode defects are rare congenital cardiac anomalies that account for less than 1% of all congenital cardiac abnormalities and only 0.08% of intracardiac shunts [1]
We present a case of a bicuspid aortic valve infective endocarditis caused by Staphylococcus aureus and complicated with annular aortic abscess resulting in acquired Gerbode defect with tricuspid valve vegetation which was undiagnosed preoperatively
Transoesophageal echocardiography (TEE) is essential in intraoperatively monitoring adult and congenital heart surgery. It gives us real-time data about the heart during the whole procedure that the adequacy of the repair can be ensured immediately through a review of trans-oesophageal echocardiography (TEE) images directly after surgery; in our case, the intraoperative TEE yield a new finding of the left ventricular outflow tract defect to the right atrium (LVOT-RA), which was not known at the time of the surgery
Summary
Gerbode defects are rare congenital cardiac anomalies that account for less than 1% of all congenital cardiac abnormalities and only 0.08% of intracardiac shunts [1]. It is defined as abnormal shunting between the left ventricle and right atrium resulting from either a congenital defect or prior cardiac insults (Figure 1). The pathophysiology underlying the development of Gerbode defect is a disease process that injuries the atrioventricular septum and leads to the abnormal shunting of blood. The most common cause of Gerbode defect has historically been congenital, an increasing trend towards acquired cases has recently been reported in the literature
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