Perivalvular pseudoaneurysm caused by streptococcus dysgalactiae in the presence of prosthetic aortic valve endocarditis.
A 62-year-old man with a medical history of aortic valve replacement was referred to our hospital with high-grade fever. Blood culture was positive for Streptococcus dysgalactiae, and the echocardiogram showed edematous aortic annulus, suggesting a perivalvular abscess. Treatment with antibiotics was started, which showed progressive improvement. The echocardiogram at 2 weeks after admission showed progression of the perivalvular abscess, resulting in the formation of a perivalvular pseudoaneruysm, which revealed rapid enlargement. The patient underwent surgical resection of a 20-mm pseudoaneurysm, originating from the right and left coronary cusp. Complete resection of the infective tissue was performed, and an aortic root replacement was done. This case highlights that a frequent follow-up should be performed in case of perivalvular abscess, because of the risk of pseudoaneurysm formation, which may cause a life-threatening outcome.
Department of Cardiovascular Surgery, Fujigaoka Hospital, Showa University, Yokohama, Kanagawa, Japan. kansaku-ths@umin.ac.jp
Daijiro
D
Hori
Kenichiro
K
Noguchi
Yohei
Y
Nomura
Hiroyuki
H
Tanaka
D000785:Aneurysm, Infected / Q000175:diagnosis / Q000382:microbiology*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001021:Aortic Valve / Q000601:surgery*; D003646:Debridement; D004452:Echocardiography; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000382:microbiology*; D006322:Heart Aneurysm / Q000175:diagnosis / Q000382:microbiology*; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000382:microbiology*; D012086:Reoperation; D013290:Streptococcal Infections / Q000175:diagnosis / Q000382:microbiology*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents