Aortic Root Abscess With Left Atrial Fistula: A Rare and Life-Threatening Complication of Infective Endocarditis

Aortic root abscesses represent severe complications of infective endocarditis, rarely resulting in fistula formation. Serial imaging is critical for early detection of disease progression and complications.

A 67-year-old man presented with atrial fibrillation and Streptococcus salivarius bacteremia. Echocardiography revealed aortic insufficiency with subvalvular vegetation. Despite intravenous antibiotics, he developed respiratory distress. Repeat echocardiography showed an aortic root abscess with subaortic-left atrial fistula requiring urgent surgical repair.

Despite early diagnosis and guideline therapy, the patient experienced clinical deterioration. This case is notable for the progression of uncomplicated aortic valve vegetations to an aortic root abscess with subaortic-left atrial fistula, noting the role of consistent imaging to identify complications and the need for surgical interventions.

Early diagnosis, multidisciplinary management, and consistent monitoring are critical in infective endocarditis. Surgery remains the gold standard for abscess and fistula repair, with percutaneous methods emerging as a less-invasive option.