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Pneumococcal aortic valvar endocarditis with atrio-ventricular perforation

Y Louagie, S Charles, B Marchandise

The Journal of Cardiovascular Surgery

|July 1, 1982

Summary

This case report details pneumococcal endocarditis complicated by a rare left ventricular-right atrial fistula, leading to cardiac failure. Surgical intervention successfully treated the endocarditis, but the patient later died from myocardial infarction.

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Area of Science:

Cardiology
Infectious Diseases
Cardiac Surgery

Background:

Pneumococcal endocarditis is a rare but severe infection affecting heart valves.
Complications can include fistula formation and rapid cardiac decompensation.
Early diagnosis and surgical intervention are critical for managing severe cases.

Observation:

A 56-year-old male presented with pneumococcal endocarditis complicated by a left ventricular-right atrial fistula and acute cardiac failure.
The patient underwent aortic valve replacement and fistula closure with pericardial patches.
Post-operative recovery from endocarditis was achieved, but the patient experienced significant morbidity.

Findings:

The patient survived the acute bacterial endocarditis and surgical repair.

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Two months post-discharge, the patient succumbed to a massive myocardial infarction.

The myocardial infarction was attributed to previously undiagnosed coronary artery disease, specifically stenosis of the anterior descending artery and circumflex vessel occlusion.

Implications:

This case highlights the complex interplay between infective endocarditis, structural cardiac complications, and underlying coronary artery disease.
Effective management requires a multidisciplinary approach addressing both infection and cardiac pathology.
Understanding rare complications like atrioventricular fistulas is crucial for surgical planning and patient outcomes.