Infective Endocarditis with Periannular Abscess and Sinus of Valsalva Aneurysm Rupture

Wei‐Chieh Lee ,Chia Chen Wu

doi:10.4172/2165-7920.1000714

Abstract

The present study reports a case of a 64-year-old man was admitted for sudden collapse. On auscultation, new grade 4/6 continuous murmur were detected and was best heard along the right sternal border. Blood culture yielded Staphylococcus haemolyticus and Escherichia coli. Despite appropriate antibiotic treatment, the patient’s condition deteriorated and he developed multiple organ failure. Transesophageal echocardiography revealed echofree spaces with periannular abscess, and two perforations at the noncoronary sinus of Valsalva aneurysms. This case was about an unusual case of prosthetic aortic valve infectious endocarditis with periannular abscess formation and noncoronary sinus of Valsalva aneurysms rupturing into the right atrium and right ventricle.

Highlights

Sinus of Valsalva aneurysms (SVAs) are rare cardiac anomalies that are mostly congenital
We report an unusual case of prosthetic aortic valve infective endocarditis (IE) with periannular abscess formation and noncoronary SVA rupturing into the right atrium (RA) and right ventricle (RV)
The Transesophageal echocardiography (TEE) findings suggested a diagnosis of recurrent prosthetic aortic valve IE with periannular abscess and ruptured noncoronary SVA and a defect in the aortic-right ventricular inflow tract (RVIT)

Summary

Introduction

Sinus of Valsalva aneurysms (SVAs) are rare cardiac anomalies that are mostly congenital. Acquired SVAs causing aortic-right atrial fistulas related to infective endocarditis (IE) are even rarer. A 64-year-old man was admitted to our emergency department due to sudden collapse. He had a history of Enterococcus faecalis-induced aortic valve IE and had undergone aortic valve replacement with Toronto SPV valve Toronto stentless porcine valve bioprosthesis (St. Jude, St. Paul, MN) six years ago. Half year before admission to our hospital, he developed infective prosthetic aortic valve endocarditis, necessitating another aortic valve replacement with Hancock-II valve (Medtronic, Minneapolis, MN) (25 mm). Electrocardiogram revealed atrial fibrillation with premature ventricular beats and right bundle branch block. Blood culture yielded Staphylococcus haemolyticus and Escherichia coli. One week after admission, the patient’s condition deteriorated and he developed multiple organ failure

Echocardiography Findings

Operative Findings

Discussion

Conclusion