Bicuspid Aortic Valve Endocarditis Research Articles

Rare complications of infective endocarditis in marfan-like morphotype: diagnosis of multiple mitral valve aneurysms and aortic root abscess using three-dimensional transesophageal echocardiography

Mitral valve aneurysm (MVA) is characterized by a saccular outpouching of the mitral leaflet, and it represents a rare condition typically associated with aortic valve endocarditis. Three-Dimensional Transesophageal Echocardiography (3D-TEE) serves as an effective tool for detecting the presence of MVA and its potential complications. In this report, we present a case involving a young man with striking images of bicuspid aortic valve endocarditis complicated by an aortic root abscess and multiple perforated mitral valve aneurysms, diagnosed using 3D TEE. This case suggests the uncommon coexistence of Marfan like morphotype, bicuspid aortic valve, and infective endocarditis as a triple mechanism in the occurrence of MVA. It underscores the significance of early and accurate imaging diagnosis for facilitating prompt surgical intervention.

Comparing clinical outcomes in bicuspid versus trileaflet aortic valve endocarditis

Abstract Background The incidence of bicuspid aortic valve infective endocarditis (BAV-IE) has been reported at 2% in contemporary BAV cohorts with an estimated risk of developing BAV-IE 11 times that of the general population with a trileaflet aortic valve (TAV). Purpose To characterise BAV-IE from a clinical and microbiological perspective and compare clinical outcomes with a cohort of individuals with trileaflet aortic valve infective endocarditis (TAV-IE). Methods The clinical records of all patients (>16 years old) admitted to a large tertiary referral centre in the United Kingdom between 2015 and 2022 with a definitive diagnosis of native aortic valve IE by Duke’s criteria were included. Clinical, echocardiographic and microbiological data were obtained. The primary outcomes were death or surgical aortic valve intervention during the indexed hospital admission. Secondary outcomes included the incidence of cardiac complications (e.g. aortic root abscess or fistula formation, IE affecting another valve or high degree atrioventricular block requiring temporary or permanent pacing). Extra-cardiac complications included embolic phenomena and thrombotic events. Results 83 patients were included (BAV-IE 34; TAV-IE 49). BAV-IE patients were significantly younger at presentation than TAV-IE patients (Table 1). There was no difference age-adjusted mortality rate between the two groups (mortality rate BAV-IE 0.20 (95% CI 0.08-0.54) versus TAV-IE 0.29 (95% CI 0.17-0.48). The rate of cardiac complications including aortic root abscess or fistula formation, and concomitant mitral valve endocarditis was greater in the BAV group, though not reaching statistical significance. Those in the BAV-IE group were more likely to develop at least moderate aortic regurgitation and have aortic valve intervention during the admission (70.6% (24/34) BAV-IE versus 46.9% (23/49) TAV-IE, p=0.03). Conclusion Despite an estimated prevalence of 1% in the general population, BAV accounted for 41% of all native AV IE cases at our institution. This study demonstrates that even in young, otherwise healthy individuals, BAV-IE has a poor prognosis with a high proportion developing structural complications. Age-adjusted mortality rates are similar to those with TAV-IE, who are often older with more co-morbidities. Though antibiotic prophylaxis is currently only recommended for those at the highest risk, these findings reinforce the importance of mitigating sources of infection in individuals with BAV. Prompt medical attention and treatment of suspected IE cases is of utmost importance as degeneration of a BAV and other cardiac complications, particularly aortic regurgitation, can rapidly develop.

Acquired Gerbode Defect Secondary to Severe Bicuspid Aortic Valve Endocarditis

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.

A rare case of anaerobic streptococci endocarditis in a young female with bicuspid aortic valve: case report.

BackgroundBicuspid aortic valve is the most common congenital cardiovascular malformation and occurs in 1–2% of the population. The haemodynamic changes appear early, leading to tissue damage and predisposing to germs attachment. The development of perivalvular extension is a constant in bicuspid aortic valve endocarditis. Infective endocarditis with anaerobic bacteria is a rare condition with a high rate of mortality.Case summaryWe report a case of a young female with bicuspid aortic valve infective endocarditis. Involved bacteria were anaerobic streptococci, and the clinical course of the diseases was very aggressive. The echocardiographic evaluation revealed aortic and mitral regurgitation, perivalvular abscess, ventricular septum defect, and pericardial effusion. The surgery approach consisted of the aortic valve replacement with a mechanical prosthesis after radical resection of aortic root abscess and reconstruction of the annulus. The ventricular septum defect was also closed with a pericardial patch. Anticoagulation started the first day after surgery. The patient was received antibiotic therapy for 10 days before and 4 weeks after surgical intervention. Evolution was very good at 1 and 6 months follow-up.DiscussionThis is a severe case of endocarditis, complicated with extensive valvular destruction, aortic root abscess, and fistula. Perivalvular complications are frequent in patients with bicuspid aortic valve endocarditis. The ‘take away’ message is that echocardiography is an essential tool for diagnosis, management, and follow-up of patients with infective endocarditis.

Abstract 12888: Discrepancy of Aortic Valve Endocarditis in Patients With Bicuspid and Tricuspid Aortic Valve

Introduction: It’s unknown if patients with Bicuspid Aortic Valve (BAV) endocarditis behave differently compared to Tricuspid Aortic Valve (TAV), and if BAV patients are more susceptible to aortic valve endocarditis. Hypothesis: We aimed to distinguish BAV and TAV infectious endocarditis, including the short and long-term outcomes after surgical treatment. Methods: From 1997-2017, 336 patients underwent surgical treatment for aortic valve endocarditis, including 63(19%) BAV, which is 10-20 times higher than the BAV incidence in the general population (1-2%), and 273(81%) TAV endocarditis. Results: Postoperatively, the BAV group had significant shorter intubation time, and less renal failure on dialysis compared to TAV group. There was no compelling difference in postoperative stroke, sepsis, pacemaker requirement and in-hospital mortality [3/65(4.6%) vs. 19/283(6.7%)] between groups. The 10-year survival was better in the BAV group than the TAV group (62% vs. 33%, p=0.004) (Figure). The significant risk factors for late mortality were renal failure on dialysis [hazard ratio (HR)=2], intravenous drug user (HR=2.4), congestive heart failure (HR=1.6), previous coronary artery bypass (HR=1.8) and liver disease (HR=2.4), all p<0.05, but not TAV (HR=1.6, p=0.14). Conclusions: In conclusion, BAV patients have a higher likelihood of infectious endocarditis requiring surgery at a younger age than TAV patients, but similar outcomes. Strong consideration of utilizing prophylactic antibiotics and early surgical treatment for BAV patients, to lower the likelihood of aortic valve endocarditis.

Is This a Satellite Orbiting Unchartered Territory?

SummaryA 27-year old female i.v. drug user presented to our institution with chest pain. She had a history of bicuspid aortic valve endocarditis with aortic root abscess repaired with bioprosthetic aortic valve replacement and pericardial patch reconstruction of the left ventricular outflow tract and non-coronary sinus 6 weeks previously.Echocardiographic and cardiac CT imaging confirmed three foci of breakdown of the pericardial patch repair with active bleeding into a large posterior pseudoaneurysm (92 mm diameter) compressing the left atrium and pulmonary artery. Following multidisciplinary discussion, the consensus was to attempt urgent percutaneous closure of the defect, given the prohibitive surgical risks.The procedure was performed under fluoroscopic and 3D-transoesophageal guidance. TOE demonstrated the pericardial patch breaches and active bleeding into the large pseudoaneurysm (Figs 1 and 2). Initial deployment of an Amplatzer atrial septal defect occluder resulted in significant flow reduction, but there remained two small peri-device leaks (Fig. 3).During an attempt to implant an additional smaller Amplatzer vascular plug (AVP-2) to rectify this, the initial device dislodged and embolised into the pseudoaneurysm. This was felt irretrievable and unlikely to be clinically significant given its containment. The embolised device freely floated within the pseudoaneurysm, uniquely akin to a satellite orbiting in space (Video 1). The secondary device was removed and initial breach was satisfactorily closed with a 15-mm-sized Amplatzer atrial septal defect occluder (third device). This was confirmed to be well-seated on real-time 3D imaging (Video 2), with negligible residual leak on TOE (Fig. 4). This is the first published case of percutaneous cardiac device embolization into a pseudoaneurysm cavity that we are aware of.

412 Survival With Favourable Outcomes following Rupture of Massive Fistulating Aortic Root Abscess Secondary to Bicuspid Aortic Valve Endocarditis

412 Survival With Favourable Outcomes following Rupture of Massive Fistulating Aortic Root Abscess Secondary to Bicuspid Aortic Valve Endocarditis

P836 Long-term survival of a rare case of pseudoaneurysm of the mitral-aortic intervalvular fibrosa as a complication of endocarditis of a bicuspid aortic valve

Abstract Introduction This is a case report of a rare condition of pseudoaneurysm of the mitral-aortic intervalvular fibrosa (P-MAIVF). Case presentation The patient was a 42-year-old Filipino gentleman. He first presented to us in 2014, for routine echocardiographic examination as a part of a preoperative assessment for a non-cardiac surgery. Patient was asymptomatic and had a history of bicuspid aortic valve, which was complicated by endocarditis in 2006, and was treated with antibiotics. Echocardiography findings: Transthoracic echocardiography (TTE) showed a bicuspid aortic valve of no hemodynamic significance . A P-MAIVF was noted by Transesophageal echocardiography as a cavity expanding posteriorly into the left atrium from the left ventricular outflow tract, with a narrow neck at the junction of the aortic posterior cusp and the anterior mitral leaflet (Figure A). The cavity showed the characteristic expansion during ventricular systole, and collapse in diastole. Color flow showed the flow through the neck in systole and emptying during diastole (Figures C,D). There was mild mitral incompetence and no fistula was detected. Diagnosis was confirmed by cardiac magnetic resonance (Figure B). Follow up Because of the known complications of this condition, some of which are potentially fatal (such as rupture into the pericardium and tamponade), he was offered a surgical repair, which he had refused. Alternative conservative follow-up strategy was implemented and we had the opportunity to follow him for more than 5 years. During these years he was asymptomatic and uncomplicated. There was no change in the size of the pseudoaneurysm or its flow pattern. Conclusion This report demonstrates a rare case of P-MAIF as a complication of bicuspid aortic valve endocarditis and a long-term patient survival of a potentially fatal condition without corrective surgery. Abstract P836 Figures A,B,C,D

Aortic root abscess presenting as alternating bundle branch block: Infective endocarditis of bicuspid aortic valve

Bicuspid aortic valve is the most common congenital cardiac malformation, affecting 1%–2% of the population. Among various complications, incidence of infective endocarditis (IE) in the bicuspid aortic valve population is high with higher rate of periannular extension resulting in conduction disturbances. Here we are reporting a rare case of infective endocarditis of bicuspid aortic valve presented with alternating bundle branch block.

Uncommon ultrasound findings due to extensive bicuspid aortic valve endocarditis

We report the case of a 32-year-old man, who was presented with dyspnoea and diffuse abdominal pain with associated vomiting about two months after surgery for aortic valve replacement due to endocarditis. The echocardiographic examination of the patient revealed uncommon findings such as pseudoaneurysm of the aortic intervalvular fibrosa (MAIVF) , perforation of the anterior mitral leaflet, large aneurysm of the perimembranous inlet ventricular septum, Gerboden flow through the perimembranous aneurysm and finally abnormal position of the tricuspid valve towards the ventricular apex.

Extrinsic Compression of the Left Anterior Descending Coronary Artery During Percutaneous Pulmonary Valve Implantation

A 49-year-old man with a history of Ross procedure 7 years prior because of bicuspid aortic valve and bacterial endocarditis developed a symptomatic pulmonary homograft dysfunction (peak systolic transvalvular gradient of 98 mm Hg with moderate insufficiency) and right heart failure ([Figs. 1][1]A

Acquired Left Ventricular to Right Atrial Shunt Following Bicuspid Aortic Valve Endocarditis

Introduction: Rheumatic heart disease and its sequalae sometime manifests into unique presentation. We report an interesting case of giant aneurysmal left atrium secondary to sever calcific mitral stenosis with tricuspid stenosis. Methods: A 35 year-old male presented with off and on breathlessness for five years. X-ray chest showed huge cardiomegalywith cardio-thoracic ratio one. ECGdemonstrated atrial fibrillation, 2D echocardiography had revealed severe calcific mitral stenosis (MVA .73 cm) with giant left atrium measuring (19.3 cm 14 cm), PASP 75 mm Hg, severe tricuspid stenosis (gradient 22/14) with dense smoke in left atrium. Results: Patient underwent successful mitral valve replacement using #29 SJM bileaflet with tricuspid commisurrotomy and obliteration of left atrial appendage under cardiopulmonary bypass. Post-operative echocardiography confirmed normal functioning valvular prosthesis with reduced size LA (12 cm) and PASP pressure (35 mm) and no tricuspid stenosis and regurgitation.

Native Aortic Valve Endocarditis Complicated by Pseudoaneurysm of Mitral-Aortic Intervalvular Fibrosa

Pseudoaneurysm of mitral-aortic intervalvular fibrosa (PA-MAIVF) is a rare complication of native aortic valve endocarditis. This region is a relatively avascular area and prone to infection during endocarditis and subsequent aneurysm formation. The rupture into the pericardial cavity and left atrium or aorta, systemic embolism, myocardial infarction secondary to left coronary compression, and sudden death are the reported complications. Herein, we present a 9-year-old boy who was diagnosed with bicuspid aortic valve endocarditis complicated by PA-MAIVF, cerebral embolism, and hemorrhage. PA-MAIVF was visualized by both two- and three-dimensional transthoracic echocardiography and ruptured into pericardial space causing a fatal outcome.

Concomitant Gerbode‐Like Defect and Anterior Mitral Leaflet Perforation after Aortic Valve Replacement for Endocarditis

We present a case of concomitant left ventricle (LV) to right atrial shunt (Gerbode-like defect) and anterior mitral leaflet perforation in a 32-year-old male after aortic valve replacement for infective endocarditis of bicuspid aortic valve. This case emphasises that intra-operative transesophageal echocardiography is a sine qua non for valvular surgical procedures.

Urgent aortic valve replacement for infective endocarditis during the 23rd week of pregnancy

Infective endocarditis is a rare but serious complication of pregnancy with high maternal and fetal mortality. Surgical intervention is an option when medical therapy fails. We report the case of a 23-year-old female with severe aortic valve regurgitation and hemodynamic compromise related to acute bacterial endocarditis of a congenital bicuspid aortic valve during the 23rd week of pregnancy. She underwent urgent aortic valve replacement and, despite implementation of known fetal-protection strategies, fetal demise occurred.

Uncommon acquired Gerbodedefect following extensive bicuspid aortic valve endocarditis

Gerbode defect is a rare type of left ventricle to right atrium shunt. It is usually congenital in origin, but acquired cases are also described, mainly following infective endocarditis, valve replacement, trauma or acute myocardial infarction. We report a case of a 50-year-old man who suffered an extensive and complex infective endocarditis involving a bicuspid aortic valve, the mitral-aortic intervalvular fibrosa and the anterior leaflet of the mitral valve. After dual valve replacement and annular reconstruction, a shunt between the left ventricle and the right atrium - Gerbode defect, and a severe leak of the mitral prosthesis were detected. Reintervention was performed with successful shunt closure with an autologous pericardial patch and paravalvular leak correction. No major complications occurred denying the immediate post-surgery period and the follow-up at the first year was uneventful.

Bicuspid aortic valve endocarditis complicated by perivalvular abscess

A 37-year-old man presenting with fever and chest pain was admitted to our hospital. Electrocardiogram showed sinus tachycardia and complete left bundle branch block. Transthoracic echocardiogram showed infective endocarditis in the bicuspid aortic valve, complicated by multiple hyperechoic vegetations and severe aortic regurgitation. Blood cultures were negative and intravenous empiric antibiotic therapy was begun. However, fever lasted for 7 days and follow-up echocardiography revealed a newly emerged perivalvular abscess. The patient eventually underwent an urgent aortic root replacement that confirmed the echocardiographic findings. Our case report emphasizes that all patients with suspected aortic valve endocarditis should undergo early and follow-up echocardiographic studies.

Bicuspid Aortic Valve Endocarditis Complicated by Mitral Valve Aneurysm

We describe a case of mitral valve aneurysm associated with concomitant aortic valve endocarditis. Aneurysms appear as a localized saccular bulge of the anterior leaflet into the left atrium and thus are often misdiagnosed as mitral valve prolapse, myxomatous mitral valve, or atrial myxoma. The presentation and management of mitral valve aneurysms are the subject of this case report.

A case report with difficulty in diagnosis between giant cell arteritis associated with bicuspid aortic valve and infectious endocarditis

A case report with difficulty in diagnosis between giant cell arteritis associated with bicuspid aortic valve and infectious endocarditis

Acute aortic dissection associated with undetected congenital bicuspid aortic valve and infective endocarditis diagnosed intraoperatively

The congenital bicuspid aortic valve (BAV) is recognized as a cause of acute aortic dissection (AAD) and also as a risk factor for infective endocarditis (IE) especially ring abscess. We experienced a case of all these combined and operated emergently. A 59-year-old man was transferred to us, and emergent operation was indicated for AAD and aortic stenosis (AS) due to BAV. However, he was strongly suspected of also having IE during the operation and the procedure was changed to a modified Bentall's method. The diagnosis was confirmed by pathological examination postoperatively. He recovered well after postoperative antimicrobial therapy without recurrent infection. It is important to remember that BAV is a risk factor for not only AAD but also IE, which sometimes occurs simultaneously and requires an emergent operation due to high mortality.