[Abnormal communications in acute bacterial endocarditis of the aortic valve]

Abnormal communications acquired during acute aortic valve bacterial endocarditis are rare but serious complications. Seven cases are reported; between the left ventricle and right atrium (3 cases), the left and right ventricles (2 cases), the aorta and right atrium (I case) and the aorta and left atrium (I case). The usual causal organisms is a staphylococcus (4 out of 7). The diagnosis is suspected on the development of atrio-ventricular block, a parasystolic murmur and sudden severe cardiac failure, but can only be confirmed by catheterisation and angiocardiography (impractical in our patients because of their poor condition). Echocardiography is of great diagnostic value. Surgical cure involves a double approach aortotomy and opening the other chamber involved), with extensive excision of the infected tissues, closure of the perforation, reconstruction of the aortic ring and implantation of an aortic valve prosthesis. The extent of the anatomical lesions affects the choice of the mode of reparation. There was no operative mortality in our series but two patients have persistent diastolic murmurs due to perivalvular leaks. In one case, recurrent infection led to the implantation of an apico-aortic tube with a fatal outcome.