Bicuspid aortic valve endocarditis complicated by perivalvular abscess

Area of Science:

• Cardiology
• Infectious Diseases
• Medical Imaging

Background:

• Infective endocarditis (IE) is a serious infection affecting heart valves, often requiring prompt diagnosis and treatment.
• Bicuspid aortic valves are predisposed to IE due to altered hemodynamics and valve structure.
• Early detection of complications such as abscess formation is critical for patient outcomes.

Observation:

• A 37-year-old male presented with fever and chest pain, diagnosed with infective endocarditis on a bicuspid aortic valve.
• Initial echocardiography revealed vegetations and severe aortic regurgitation; however, negative blood cultures and persistent fever prompted further investigation.
• A follow-up echocardiogram identified a new perivalvular abscess, indicating disease progression despite antibiotic therapy.

Findings:

• The case highlights the diagnostic challenges in IE, particularly with negative blood cultures.
• The development of a perivalvular abscess underscores the aggressive nature of IE in certain patient populations.
• Urgent aortic root replacement was necessary, confirming the echocardiographic findings of abscess and severe valvular damage.

Implications:

• This case emphasizes the critical role of serial echocardiography in suspected aortic valve endocarditis to detect subtle or evolving complications.
• Timely surgical intervention, guided by imaging, is essential for managing complex IE cases with abscess formation.
• Clinicians should maintain a high index of suspicion for IE complications, even with initial negative investigations.