Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2020 Aug 27:21:e923023.
doi: 10.12659/AJCR.923023.

Unusual Complications of Infective Endocarditis

Maria S Bonou  1 , Eva D Papadimitraki  1 , Chris J Kapelios  1 , John Barbetseas  1 , Nora-Athina Viniou  2
Affiliations
Case Reports

Unusual Complications of Infective Endocarditis

Maria S Bonou et al. Am J Case Rep. .

Abstract

BACKGROUND Despite advances in management, infective endocarditis remains a condition with high in-hospital and post-discharge mortality, especially when it is complicated by perivalvular extension and heart failure (HF). CASE REPORT Herein we describe two illustrative cases of endocarditis. The first case was complicated by left ventricle to right atrial fistula. The second cased was complicated by valvular perforation with a "windsock" appearance. Both patients developed acute HF. CONCLUSIONS Fistulas and severe valvular regurgitation are among the major causes of acute HF in the setting of infective endocarditis. In such cases, surgery should be considered to decrease mortality.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: None declared

Figures

Figure 1
Figure 1
Transesophageal echocardiogram, three chamber-view. A ruptured abscess to the left ventricular outflow tract (LVOT), forming a pseudoaneurysm, is visible adjacent to the aortic valve prosthesis (AVP). LA – left atrium; LV – left ventricle.
Figure 2
Figure 2
Transesophageal echocardiogram, mid-esophageal short axis view, aortic valve level. A large pseudoaneurysm around the annulus of the prosthetic aortic valve (AVP), as well as vegetations (arrow) on the tricuspid valve (TV) can be seen. LA – left atrium; RA – right atrium; RV – right ventricle.
Figure 3
Figure 3
Transesophageal echocardiogram, mid-esopheageal short axis view, aortic valve level, color Doppler interrogation. The flow into the pseudoaneurysm surrounds the aortic prosthesis (AVP) annulus, forming a rim, and there is a fistula (arrow) between the pseudoaneurysm and the right atrium (RA). LA – left atrium.
Figure 4
Figure 4
Transesophageal echocardiogram, mid-esophageal four-chamber view. Perforation of the anterior mitral valve leaflet, with “windsock” appearance (arrow), is shown. LA – left atrium; LV – left ventricle; RA – right atrium.
Figure 5
Figure 5
Transesophageal echocardiogram, mid-esophageal four-chamber view, color Doppler interrogation. There is severe mitral valve regurgitation through the perforation (arrow) of the anterior mitral valve leaflet. Localization of the jet indicates mitral valve perforation. LA – left atrium; LV – left ventricle; RA – right atrium.
Video 1
Video 1
Transesophageal echocardiogram, three-chamber view. An oscillating mass corresponding to a vegetation can be seen on the aortic prosthesis. The pseudoaneurysm with the appearance of a large echo-free perivalvular cavity exhibiting pulsatile flow also can be seen clearly.
Video 2
Video 2
Transesophageal echocardiogram, mid-esophageal short axis view, aortic valve level. The cavity now surrounds the aortic prosthesis like a rim and there is a fistula between the LVOT and the right atrium. Vegetations are seen on both the aortic prosthesis and the atrial surface of the tricuspid valve. Tricuspid valve endocarditis ensued secondarily as a jet lesion.
Video 3
Video 3
Transesophageal echocardiogram, mid-esopheageal short axis view, aortic valve level, color Doppler interrogation. There is a continuous flow between the left ventricular outflow tract and the right atrium. The jet strikes the atrial surface of the tricuspid valve.
Video 4
Video 4
Transesophageal echocardiogram, mid-esophageal four-chamber view. Perforation of the anterior mitral valve leaflet, with “windsock” appearance.
Video 5
Video 5
Transesophageal echocardiogram, mid-esophageal four-chamber view, color Doppler interrogation. There is severe mitral valve regurgitation through the perforation of the anterior mitral valve leaflet.
See this image and copyright information in PMC

References

    1. Habib G, Erba PA, Iung B, et al. Clinical presentation, aetiology and outcome of infective endocarditis. Results of the ESC-EORP EURO-ENDO (European infective endocarditis) registry: A prospective cohort study. Eur Heart J. 2019;40:3222–32. - PubMed
    1. Habib G, Lancellotti P, Antunes MJ, et al. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM) Eur Heart J. 2015;36:3075–128. - PubMed
    1. Baddour LM, Wilson WR, Bayer AS, et al. Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications: A scientific statement for healthcare professionals from the American Heart Association [published correction appears in Circulation. 2015 Oct 27; 132(17): e215] [published correction appears in Circulation. 2016 Aug 23; 134(8): e113] [published correction appears in Circulation, 2018 Jul 31; 138(5): e78–e79] Circulation. 2015;132(15):1435–86. - PubMed
    1. Pericàs JM, Llopis J, Muñoz P, et al. A contemporary picture of enterococcal endocarditis. J Am Coll Cardiol. 2020;75(5):482–94. - PubMed
    1. Saeed K, Bal AM, Gould IM, et al. An update on Staphylococcus aureus infective endocarditis from the International Society of Antimicrobial Chemotherapy (ISAC) Int J Antimicrob Agents. 2019;53:9–15. - PubMed

Publication types