Diastolic aorto-right-atrial fistulation in aortic and tricuspid valve endocarditis

An Unusual Case of a Double Tricuspid and Mitral Valves Infective Endocarditis Complicated by Multiple Septic Embolisms Secondary to an Atrial Septal Defect: A Case Report and Review of Literature

Multivalvular endocarditis (MVE) is an uncommon infection that mostly involves mitral and aortic valves, and it is related to a higher risk of congestive heart failure and a higher mortality. We described a case of a bilateral MVE and performed a review of the literature on similar clinical cases. We reported an unusual case of a 68-year-old male patient with a tricuspid and mitral infective endocarditis due to a methicillin-resistant Staphylococcus aureus complicated by multiple right- and left-sided septic embolization (lungs, brain, spleen, L2-L3 vertebral bones) due to an unknown atrial septal defect identified and repaired during cardiac surgery. Despite the severity of the clinical case, the patient experienced a good clinical outcome also thanks to a multidisciplinary approach. We identified 21 case reports describing bilateral MVE. A multidisciplinary approach is essential in the management of valve diseases to improve the prognosis of patients, especially in bilateral MVE.

An aorto-right-atrial fistula caused by infective endocarditis in a patient with an anomalous coronary artery from the opposite sinus

A 35-year-old man presented with an anomalous right coronary artery from the opposite Valsalva sinus. He developed an aorto-right-atrial fistula due to destructive infective endocarditis undetected during preoperative computed tomography. Intraoperative retrograde cardioplegia and direct insertion of the coronary probe demonstrated that the right coronary ostium was in the left Valsalva sinus near the left coronary ostium. The right-sided aortic root and right atrium were severely damaged. This coronary anomaly allowed us to perform a unique aortic root reconstruction without touching or injuring the right coronary artery. Two years later, the patient remains well without complications. This novel reconstruction treatment is feasible for destructive infective endocarditis in such patients.

Unusual Presentation of Aortic Valve Infective Endocarditis in a Dog: Aorto-Cavitary Fistula, Tricuspid Valve Endocarditis, and Third-Degree Atrioventricular Block

Simple Summary

In dogs, infective endocarditis represents a rare but clinically relevant disease that typically involves the aortic and/or mitral valve. Transthoracic echocardiography plays an essential role in the diagnosis, prognosis, and monitoring of such a condition. Typical echocardiographic signs of disease progression include left-sided cardiac dilatation and extension of aortic and/or mitral vegetative lesions. Nevertheless, unexpected complications can sometimes develop, especially in the case of the erosion of the periannular tissue caused by lytic enzymes produced by bacteria. This case report describes the coexistence of multiple, uncommon complications of aortic valve infective endocarditis in a dog, namely, aorto-cavitary fistula, tricuspid valve endocarditis and third-degree atrioventricular block. In this study, the combination of the ante mortem (clinical and echocardiographic) and post mortem (gross pathology and histopathology) findings allowed us to gain detailed information on the disease process, its atypical complications, and the associated emodynamic consequences.

Abstract

A 2-year-old Boxer with a history of subaortic stenosis and immunosuppressant therapy developed aortic valve infective endocarditis. On echocardiographic examination with simultaneous electrocardiographic tracing, multiple uncommon periannular complications of the aortic valve endocarditis were found, including aorto-cavitary fistula with diastolic left-to-right shunt, tricuspid valve endocarditis, and third-degree atrioventricular block. Necropsy confirmed the above echocardiographic findings. Although aortic valve endocarditis represents a well-known disease entity in dogs, the dynamic nature of this condition may allow development of complex and uncommon echocardiographic features.