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Acquired Gerbode Defect in a Patient With Infective Endocarditis of Bicuspid Aortic Valve

Mohammed Mahdi1, Muhammet Ozer1, Bipinpreet Nagra2

  • 1Internal Medicine, Capital Health Regional Medical Center, Trenton, USA.

Cureus
|July 9, 2021
PubMed

Insights

Aortic valve abscess, a severe infective endocarditis complication, can be missed by initial echocardiography. This case highlights a Streptococcus agalactiae infection with abscess and Gerbode defect mimicking tricuspid valve vegetation.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Medical Imaging

Background:

  • Infective endocarditis (IE) is a serious infection affecting heart valves.
  • Aortic valve abscess is a life-threatening complication of IE.
  • Transthoracic echocardiography (TTE) is the first-line imaging for suspected IE, but has limitations in detecting subtle cardiac complications.

Observation:

  • This case involves a bicuspid aortic valve infected by Streptococcus agalactiae.
  • The patient developed an aortic valve abscess and an acquired Gerbode defect.
  • Initial transthoracic echocardiography revealed findings suggestive of a tricuspid valve vegetation.

Findings:

  • The aortic valve abscess and Gerbode defect were confirmed as complications of infective endocarditis.
  • Streptococcus agalactiae was identified as the causative pathogen.
  • Transthoracic echocardiography findings were misleading, mimicking a different cardiac anomaly.

Implications:

  • Transesophageal echocardiography (TEE) is crucial for accurate diagnosis when TTE is inconclusive or clinical suspicion is high.
  • Early and accurate diagnosis of aortic valve abscess and associated defects is vital for timely intervention.
  • This case underscores the importance of considering advanced imaging in complex IE cases, especially with atypical presentations.

Keywords:
acquiredbicuspid aortic valvegerbode defectinfective endocarditisstreptococcus agalactiae

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