Bicuspid Aortic Valve in Pregnancy Complicated by Aortic Valve Vegetation, Aortic Root Abscess, and Aortic Insufficiency

Abstract Background Bicuspid 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 summary We 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. Discussion This 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.

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An aortic root abscess in a patient with a bicuspid aortic valve: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa209 ◽

2020 ◽

Vol 4 (5) ◽

pp. 1-6

Author(s):

Elyse Balzan ◽

Alexander Borg

Keyword(s):

Infective Endocarditis ◽

Aortic Valve ◽

Bicuspid Aortic Valve ◽

Aortic Root ◽

Complete Recovery ◽

Operative Management ◽

Native Valve ◽

Night Sweats ◽

Aortic Root Abscess ◽

Long Course

Abstract Background Infective endocarditis is a serious infection associated with high mortality and severe complications, such as heart failure, uncontrolled infection, and embolic events. Certain populations, including individuals with a prosthetic valve and those with native valve disease, such as bicuspid aortic valve, are considered to be more at risk of developing infective endocarditis. Case summary A 51-year-old previously healthy male presented with a 2-week history of persistent fever, malaise, and night sweats despite taking a long course of oral antibiotics. Examination was unremarkable; however, blood tests showed elevated inflammatory markers. Three sets of blood cultures revealed coagulase-negative gram-positive cocci (later identified as Staphylococcus lugdunensis), and the patient was subsequently started on IV antibiotics. His echocardiography showed a bicuspid aortic valve with severe regurgitation, and an aortic root abscess surrounding a dilated aortic root. In view of the presence of locally uncontrolled infection, the patient was referred for urgent debridement of the abscess and replacement of the aortic valve with tissue prosthesis. Fortunately, after a total of 6 weeks of IV antibiotics and successful operative management, our patient made a complete recovery. Discussion The development of an aortic root abscess occurs in 10–40% of cases of aortic valve endocarditis. Clinically, this should be suspected in any patient with endocarditis who fails to improve despite appropriate antibiotic therapy. This case demonstrates that severe infective endocarditis can develop in apparently healthy individuals due to underlying cardiac abnormalities.

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

Indian Heart Journal ◽

10.1016/j.ihj.2015.03.003 ◽

2015 ◽

Vol 67 (3) ◽

pp. 266-267

Author(s):

Rakesh Jain ◽

Muneer Kader ◽

C.G. Sajeev ◽

M.N. Krishnan

Keyword(s):

Infective Endocarditis ◽

Aortic Valve ◽

Bicuspid Aortic Valve ◽

Aortic Root ◽

Bundle Branch Block ◽

Aortic Root Abscess

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Bicuspid Aortic Valve Repair for Aortic Insufficiency Without Aortic Root Aneurysm: Does Preoperative Annular Diameter Matter for Long-term Durability?

Structural Heart ◽

10.1080/24748706.2019.1589259 ◽

2019 ◽

Vol 3 (sup1) ◽

pp. 65-65

Author(s):

Mary A. Siki

Keyword(s):

Aortic Valve ◽

Bicuspid Aortic Valve ◽

Aortic Root ◽

Aortic Insufficiency ◽

Aortic Valve Repair ◽

Valve Repair ◽

Aortic Root Aneurysm

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Bicuspid aortic valve infective endocarditis and aortic root abscess presenting initially as splenic infarctions

Proceedings of Singapore Healthcare ◽

10.1177/20101058211019438 ◽

2021 ◽

pp. 201010582110194

Author(s):

Raja Ezman Faridz Raja Shariff ◽

Hafisyatul Aiza Zainal Abidin ◽

Sazzli Kasim

Keyword(s):

Abdominal Pain ◽

Infective Endocarditis ◽

Aortic Valve ◽

Bicuspid Aortic Valve ◽

Aortic Root ◽

Abdominal Sepsis ◽

Systemic Review ◽

Intravenous Antibiotics ◽

Aortic Root Abscess ◽

Uncommon Case

Infective endocarditis (IE) commonly complicates bicuspid aortic valve. We report an uncommon case of bicuspid aortic valve (BAV) IE with aortic root abscess (ARA), presenting initially with abdominal pain due to splenic infarcts, delaying prompt diagnosis. A 38-year-old gentleman presented with fever and abdominal pain. He was treated for intra-abdominal sepsis, was started on intravenous antibiotics and had a computed tomography scan of the abdomen that revealed a large splenic infarct. The patient deteriorated, prompting further investigations, including echocardiography due to findings of a new murmur, signs of embolisation and blood cultures revealing Staphylococcus aureus. This revealed an otherwise unknown BAV with aortic valve vegetation and ARA. IE and ARA commonly affect patients with bicuspid aortic valve, and our case highlights the importance of systemic review, as IE often manifest clinically in various forms.

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