Prosthetic Valve Endocarditis and Aortic Root Abscess: A Case of High-Risk Infection

Aortic root abscess is a severe complication of infective endocarditis (IE), particularly in patients with prosthetic valves, nearly doubling mortality risk. Due to the potential for rupture and systemic spread, urgent surgical intervention is recommended. We present the case of a 77-year-old man with a recent aortic valve replacement and a history of discitis who presented with non-specific symptoms, complete heart block, and persistent Staphylococcus epidermidis bacteremia. Multimodal imaging, including positron emission tomography (PET) and CT coronary angiography, confirmed an aortic root abscess. Following the IE multidisciplinary team (MDT) recommendations, the patient underwent successful aortic valve and root repair. Post-operatively, he required a pacemaker and dual antibiotic therapy for eight weeks, with no further infection detected. This case highlights the diagnostic challenges of prosthetic valve endocarditis, the critical role of multimodal imaging in detecting complications, and the necessity of early surgical intervention. The development of a heart block underscores the impact of aortic root abscess on conduction pathways. MDT management was essential in optimising patient outcomes.