Native aortic valve enterococcal endocarditis with myocardial paravalvular abscess

Abstract

INTRODUCTION Enterococcal endocarditis accounts for 10 to 20% of all cases of bacterial endocarditis. Organisms belonging to the genus Enterococcus are the third most common cause of endocarditis after Streptococcus viridans and Staphylococcusaureus. Enterococcus faecalis causes approximately 90% of all enterococcal infections, and Enterococcus faecium about 10%. Enterococcal infections are most common in older men after a genitourinary tract manipulation or in women of childbearing age. Enterococcal endocarditis may affect both native and prosthetic valves. The aortic valve is affected more often than the mitral valve, and enterococcal endocarditis may be complicated by abscess. Enterococcal endocarditis is most often left sided, even in intravenous drug users, and most commonly presents subacutely. Fever and elevated erythrocyte sedimentation rate (ESR) are present in 90% of patients. Fatality rates average less than 20% and relapse occurs in less than 10%. Complications include stroke, congestive heart failure, and subarachnoid hemorrhage. The occurrence of a paravalvular abscess in the course of an acute endocarditis of the aortic valve indicates an advance stage of the infection and complicates endocarditis in 20 to 30% of cases. In one report, 27 of 95 patients at autopsy, with a native valve endocarditis had paravalvular abscess. Myocardial abscess occurs in approximately 5% of cases of enterococcal endocarditis. We report a case of an enterococcal endocarditis complicated by a large posterior aortic cusp paravalvular abscess, diagnosed by transesophageal echocardiogram (TEE).