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Perivalvular Mitral Abscess Fistulised to the Pericardial Cavity Revealing Staphylococcal Endocarditis

Paul Desaint1, Anthony Chauvat2, Thomas Garaud1

  • 1Service de Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France.

Heart, Lung & Circulation
|November 15, 2017
PubMed
Abstract

Insights

A rare complication of infective endocarditis, a perivalvular abscess, can lead to a fistula to the pericardial cavity. Staphylococcus aureus was identified as the cause in a fatal case of mitral endocarditis.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Perivalvular abscesses in infective endocarditis can rarely form fistulas into the pericardial cavity.
  • Staphylococcus aureus is frequently implicated in these severe cases.

Observation:

  • A 66-year-old female presented with severe sepsis due to mitral endocarditis.
  • An unexpected cardiac arrest occurred shortly after admission.
  • Imaging revealed a perivalvular mitral abscess with a fistula to the pericardial cavity.

Findings:

  • Despite aggressive treatment including surgery and antibiotics, the patient experienced a fatal outcome.
  • Blood cultures, mitral valve tissue, and pericardial fluid all tested positive for methicillin-sensitive Staphylococcus aureus.

Implications:

  • This case highlights a rare but potentially fatal complication of infective endocarditis.
  • Clinicians, particularly intensivists, should maintain a high index of suspicion for this condition in patients with Staphylococcus aureus endocarditis and perivalvular abscesses.
Keywords:
Infective endocarditisMyocardial fistulaPericarditisPerivalvular abscessStaphylococcus aureus

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