Pneumococcal aortic valvar endocarditis with atrio-ventricular perforation

A case of pneumococcal endocarditis, complicated by a left ventricular-right atrial fistula and a rapidly progressing cardiac failure in a 56 year-old man, is reported here. In the acute period, an aortic valve prosthesis was installed and the atrio-ventricular fistula was closed with patches of pericardium. After serious post-operative complications, the patient left the clinic, cured of his bacterial endocarditis. He unfortunately died two months later of a massive myocardial infarction caused by a previously unrecognized atheromatous stenosis of the anterior descending branch and occlusion of the circumflex vessel. The authors discuss the bacteriological, anatomopathological and clinical aspects of this rare complication of bacterial endocarditis in light of the current available literature.