Abstract
atrial surface of the posterior mitral leaflet, which was perforated and caused mild mitral regurgitation. The patient was stable and afebrile on antibiotic treatment while awaiting valve surgery, when he presented sudden electromechanical dissociation and died. The autopsy showed cardiac tamponade caused by a hemopericardium (Figure 1) and endocarditis of the posterior mitral leaf, which was perforated and complicated by a perivalvular myocardial abscess that was fistulized to the pericardial cavity (Figures 2 and 3 [detail]). Inactive chronic liver disease was also found. Sudden death caused by a massive hemopericardium and cardiac tamponade secondary to a fistulized myocardial abscess is an extremely uncommon, fatal complication of infectious endocarditis.
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