Aortic root abscess from Enterococcus faecalis infective endocarditis: Case report and brief review of the literature

Hathaway, Quincy A.; Balar, Aneri B.; Mallicoat, Taylor A.; Voss, Jeffery A.; Amin, Md. Shahrier; Lakhani, Dhairya A.; Kim, Cathy

doi:10.1016/j.radcr.2022.08.011

Cited by 3 publications

(1 citation statement)

References 25 publications

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“… 2 One of the most severe, life-threatening complications of IE remains perivalvular and ARA formation due to the high risk of spontaneous rupture and continued spread of organisms within the aorta and surrounding organs. 3 This complication presents with a notably high mortality rate ranging from 12 to 30% for native and up to 50% for prosthetic valve–associated ARA. Risk factors contributing to increased mortality include heart defects, prosthetic valves, a history of intravenous drug use, and delayed treatment initiation.…”

Section: Discussionmentioning

confidence: 99%

Angina pectoris? Fake news: a case report of infective endocarditis with giant aortic root abscess detected by cardiac magnetic resonance imaging

Wissel,

Drayß,

Christa

et al. 2024

European Heart Journal - Case Reports

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Background Infective endocarditis (IE) is a rare disease associated with high mortality rates. Clinical presentation is highly variable with a time interval between first onset of symptoms and diagnosis > 1 month in 25% of patients. We present a case of aortic valve endocarditis with aortic root abscess (ARA) with chest pain and ischaemic changes on the electrocardiogram (ECG). Case summary A 59-year-old Caucasian male with a known bicuspid aortic valve presented at our emergency department with a 2-week history of malaise, subfebrile temperatures, and chest pain episodes. The ECG exhibited ischaemic changes, and laboratory workup showed elevated inflammatory markers and troponin levels. Coronary angiography revealed a one-vessel coronary artery disease with a borderline significant stenosis of the left circumflex artery. Cardiac magnetic resonance imaging showed a large aortic valve vegetation with an ARA expanding intramyocardially, which was not seen on bedside echocardiography. The patient was set on intravenous (i.v.) antibiotics and urgently referred for surgery. The patient received surgical aortic root and valve replacements, reconstruction of the anterior mitral leaflet, and a venous bypass. After successful surgical management followed by 6 weeks of i.v. antibiotics, the patient completely recovered. Discussion Diagnosing IE in atypical cases, such as those with ischaemic ECG changes, remains challenging. Infective endocarditis should be considered as an early differential diagnosis in individuals with prosthetic or native valve disease. Infective endocarditis poses a significant risk for perivalvular and ARA formation with high mortality. Aortic root abscess may present with unspecific symptoms or unusual ECG changes and might be missed in standard transthoracic echocardiography in up to 30% of cases. Multimodal imaging can help in establishing a prompt and accurate diagnosis, aid in timely treatment and mitigating the risk of complications of IE.

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Section: Discussionmentioning

confidence: 99%

Angina pectoris? Fake news: a case report of infective endocarditis with giant aortic root abscess detected by cardiac magnetic resonance imaging

Wissel,

Drayß,

Christa

et al. 2024

European Heart Journal - Case Reports

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Anomalous coronary artery masquerading as a root abscess: a case report

Watkins,

EL-Andari,

Liu

et al. 2024

Future Cardiology

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Unusual location of aortic root abscess as a complication of bicuspid aortic valve infective endocarditis by a rare organism

Khan,

Tipoo,

Syed

et al. 2024

BMJ Case Rep

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A man in his 50s with diabetes, hypertension and history of multiple percutaneous coronary interventions presented with 3 weeks of fever and worsening shortness of breath. There was clinical suspicion of infective endocarditis with raised infective parameters. Transthoracic echocardiogram showed abnormally thickened, bicuspid aortic valve with suspicion of paravalvular aortic root abscess. Transoesophageal echocardiogram identified large vegetation on aortic valve and non-homogeneous area around the aortic root towards the right ventricular outflow tract, which was further confirmed as paravalvular aortic root abscess on cardiac CT. Blood cultures revealed a rare organism ‘Burkholderia cepacia’. The patient responded well to intravenous antibiotics and surgical treatment with debridement of aortic root abscess, patch repair of aortic root and aortic valve replacement with a mechanical valve.

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Aortic root abscess from Enterococcus faecalis infective endocarditis: Case report and brief review of the literature

Cited by 3 publications

References 25 publications

Angina pectoris? Fake news: a case report of infective endocarditis with giant aortic root abscess detected by cardiac magnetic resonance imaging

Angina pectoris? Fake news: a case report of infective endocarditis with giant aortic root abscess detected by cardiac magnetic resonance imaging

Anomalous coronary artery masquerading as a root abscess: a case report

Unusual location of aortic root abscess as a complication of bicuspid aortic valve infective endocarditis by a rare organism

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