Mitral paravalvular abscess with left ventriculo-atrial fistula in a patient on dialysis.
BACKGROUND
Infective endocarditis in hemodialysis patients is challenging but is becoming more common recently.


METHODS
A 64-year-old man with end-stage renal disease on hemodialysis presented with infective endocarditis of mitral valve and coronary artery disease after commencing training for home hemodialysis. During a course of antibiotic treatment the patient developed left ventriculo-atrial fistula due to mitral paravalvular abscess. Abscess debridement followed by reconstruction of the mitral annulus with fresh autologous pericardial patch and mitral valve replacement using a mechanical prosthesis with concomitant coronary artery bypass grafting was performed successfully.


CONCLUSIONS
Timely diagnosis, proper antibiotic treatment and early surgical intervention including aggressive debridement should improve the outcome of this high-risk disease.
Kitamura
Tadashi
T
Department of Cardiothoracic Surgery, Royal Adelaide Hospital, Adelaide SA, Australia. funcorogash@hotmail.com
Edwards
James
J
Khurana
Suchi
S
Stuklis
Robert G
RG
D000038:Abscess / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003646:Debridement; D017548:Echocardiography, Transesophageal; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D005402:Fistula / Q000382:microbiology* / Q000601:surgery; D006325:Heart Atria / Q000382:microbiology* / Q000601:surgery; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation; D006352:Heart Ventricles / Q000382:microbiology* / Q000601:surgery; D006437:Hemodialysis, Home / Q000009:adverse effects; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000601:surgery; D010400:Penicillin G / Q000031:analogs & derivatives / Q000627:therapeutic use; D019651:Plastic Surgery Procedures; D013203:Staphylococcal Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D013211:Staphylococcus aureus / Q000302:isolation & purification
D000900:Anti-Bacterial Agents; C016262:benzylpenicillenic acid; D010400:Penicillin G