title: Fatal rupture of aortic root abscess following native aortic valve enterococcal endocarditis.
abstract: We describe the case of a 66-year-old male, who was referred to our cardiology department with suspected endocarditis, following an enterococcal bacteremia. Transesophageal echocardiography showed vegetations on a native trileaflet aortic valve. Having been prescribed intravenous amoxicillin and gentamicin, to which he initially responded, the patient became increasingly breathless during the third week of treatment. Although lung fields were clear and there were no changes to a pre-existing heart murmur on physical examination, transthoracic echocardiography and Doppler color flow imaging revealed that an aortic root abscess had ruptured and formed a left-to-right shunt. The patient was transferred to a specialist cardiac center, but was unsuitable for major surgery and died a week later. We discuss this rare and devastating complication of infective endocarditis.
authors.affiliation: Department of Cardiology, Prince Philip Hospital, Llanelli, United Kingdom; Cardiff University School of Medicine, University Hospital of Wales, Cardiff, United Kingdom. Electronic address: nima.razii@doctors.org.uk.
authors.forename: Nima
authors.initials: N
authors.lastname: Razii
authors.affiliation: Department of Cardiology, Prince Philip Hospital, Llanelli, United Kingdom. Electronic address: lena.izzat@wales.nhs.uk.
authors.forename: Lena M
authors.initials: LM
authors.lastname: Izzat
mesh_terms: D000038:Abscess / Q000150:complications* / Q000000981:diagnostic imaging; D000368:Aged; D001019:Aortic Rupture / Q000209:etiology*; D001021:Aortic Valve / Q000000981:diagnostic imaging; D004452:Echocardiography; D017548:Echocardiography, Transesophageal / Q000009:adverse effects; D004697:Endocarditis, Bacterial / Q000150:complications* / Q000000981:diagnostic imaging; D017809:Fatal Outcome; D006801:Humans; D008297:Male
keywords: Aortic valve endocarditis; Echocardiography; Endocarditis complications; Heart failure; Left-to-right shunt; Perivalvular abscess rupture