Sub-aortic tunnel stenosis complicated by infective endocarditis: a case report

Tunnel sub-aortic stenosis is a very unusual form of obstruction to left ventricular outflow. Endocarditis involving this congenital anomaly is extremely rare and not described in literature. We report the case of a 45-year-old woman who was diagnosed with a severe left ventricle outflow obstruction because of sub-aortic tunnel and was proposed for elective surgery. One month after diagnosis of her heart disease, she presented with fever and deterioration of general condition. Diagnosis of infective endocarditis secondary to a community acquired streptococcus viridans was confirmed on the basis of biological and echocardiographic abnormalities. The evolution was fatal because of multivalvular destruction and severe left ventricle dysfunction, despite rapid surgery and antibiotherapy. In this case report, we describe an extremely rare situation and we insist on the aggressive character of infective endocarditis in sub-aortic tunnel. We also emphasize the importance of antibioprophylaxis in this specific condition.