Case Study

A 48-year-old man, diagnosed with infective endocarditis (IE), had been in hospital for five days. Blood cultures had been consistently positive for Staphylococcus aureus. Intravenous antibiotic treatment had been administered since hospitalization and modified as per culture results. Transesophageal echocardiography (TEE) on the second day in hospital revealed vegetations on the ventricular aspect of the coronary aortic cusps, the largest measuring 8 mm in length with moderate aortic regurgitation, a large perforation of the anterior mitral leaflet with moderately severe mitral regurgitation, and suspicious presence of a small abscess in the aor-tomitral curtain in the form of a very small area with minimal echolucency. Cardiac surgery was consulted, and the decision was made to continue medical therapy and repeat TEE in two days. On day 7 after admission, a repeat TEE confirmed the presence of an abscess in the previously suspected location in the aortomitral curtain, significantly increased in size compared to the previous TEE images. Cultures were negative, but leukocytosis and fever persisted. The patient was taken to the operative room the following day for urgent surgery. The operation involved removal of the infected and insufficient aortic valve together with the infected aortic root and removal of the aortomitral curtain containing the abscess. An aortic homograft was used to replace the removed aortic root and valve, and the anterior mitral leaflet accompanying the homograft was used to construct a new aortomi-tral curtain. The edges of the perforation in the anterior leaflet of the native mitral valve were first debrided of small vegetations, and an autologous pericardial patch was used to repair the defect. Surgery was then concluded and the patient was sent in a stable condition to the intensive care unit for postoperative care and completion of an antibiotic course.

This case illustrates the importance of early involvement of cardiac surgery in the care of an IE patient and the significance of treating present, or preventing imminent, hemody-namic instability, even in the face of active infection. It also underscores the role of TEE as a valuable means for diagnosis and follow-up.

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