Infective endocarditis in two young men with previously undiagnosed bicuspid aortic valves

Infective endocarditis (IE) is an uncommon, potentially life-threatening microbial infection of the endocardial surface of the heart. An increased risk for IE is associated with a variety of pre-existing structural intracardiac conditions, including a bicuspid aortic valve, which provide a nidus for infection. A bicuspid aortic valve affects 0.5 to 2% of the population, the majority of patients are male, and patients usuallyremain unaware of their condition until infection or calcific valvular dysfunction occurs. We report two cases of native valve IE in otherwise healthy young men seen within a recent two-month period; both cases involved a previously undiagnosed bicuspid aortic valve and required a combination of aggressive antimicrobial therapy and early surgery as definitive treatment. Any patient, especially a young male, presentingwith a febrile illness and a previously or newly diagnosed heart murmur should raise the index of clinical suspicion for this disease.