Author + information
- Seth Fakess and
- Stephanie Saucier
Infective endocarditis (IE) is a known complication of patients with congenital bicuspid aortic valves. Prompt recognition of echocardiographic changes are important for early valve replacement.
34-year-old Caucasian male with known bicuspid aortic valve and ascending aortic aneurysm presented with acute hypoxic respiratory failure and chest pain. Initial ischemic workup was negative. CT angiography of the chest to rule out aortic dissection revealed calcified aortic valve (Fig 1A). Chest x-ray showed bilateral pulmonary edema (Fig 1B). Transthoracic echocardiogram revealed severely calcific aortic valve with severe aortic insufficiency. Aortic pressure half time (PHT) of 250 milliseconds prompting cardiothoracic surgery evaluation.
This patient met two class I indications for emergent aortic valve replacement published in the 2015 European Society of Cardiology guidelines for IE. Transesophageal echocardiogram was performed showing severe aortic valve calcification believed to be obstructing view of a vegetation (Fig 1C). Severe aortic insufficiency was diagnosed with PHT of 112 milliseconds (Fig 1D). Emergent surgery revealed aortic valve vegetations with fistula formation from the pulmonary artery to aorta (Fig 1E-G).
The case highlights the need for a multi-disciplinary approach to the assessment of patients suspected of having infective endocarditis in the presence of indications for early operative management.
Poster Hall, Hall F
Saturday, March 16, 2019, 10:00 a.m.-10:45 a.m.
Session Title: FIT Clinical Decision Making: Valvular Heart Disease 1
Abstract Category: Valvular Heart Disease
Presentation Number: 1117-206
- 2019 American College of Cardiology Foundation