Published Paper Details:

Infective endocarditis is a very common heart disease that occurs both on native and prosthetic valves. It may present with very different aspects and is actually highly associated with deadly complications .A 77 yo with multiple risk factors and history of cardiac surgery by a coronary artery bypass associated to aortic root replacement by a bentall procedure, was admitted with fever and signs of infection; cardiac examination revealed a 3/6 systolic aortic murmur and blood cultures grew immediately enterococcus feacalis.EKG showed a complete heart block. TEE revealed a sub valvular endocarditis associated to a thickened aortic valve with severe stenosis and a likely abscess on a tickned trigone. Cardiac CT confirmed an ungoing abscess and a 14mm vegetation , and a pseudoaneurysm of the membranous septum just around the aortic annulus ,permeable coronary artery bypass graft but an occluded right coronary artery. While a CAP CT revealed a splenic embolus. Antiobiotic was conducted and the patient underwent a reconstructive surgery by bentall replacement associated to CABG bridging , a gastric pacemaker and a primary closure of a peroperative unexpectedly discovered Left ventricule - right atrium fistula.A post operative pulmonary embolism was diagnosed on controle Chest scan and atrial fibrillation occurred the following days. The complications of PVE are multiple and more difficult to handle. Septic embolism associated with PVE significantly increases mortality and morbidity. Similar to Native Valve Endocarditis it may manifest as cerebral, splenic, or renal abscess. Extension of such abscesses at the aortic root can destroy the mitralaortic intervalvular fibrosa and result in pseudoaneurysm formation. Rupture of a pseudoaneurysm can cause fistulous communications between the aorta and the left atrium, left ventricle, or pulmonary artery. Because of the close proximity to the right atrium, such paravalvular and root abscesses can also rupture into the right atrium resulting in a fistulous communication between aorta and right atrium. Extension of aortic root abscess may involve the conduction system, resulting in AV conduction disturbances as in our patient.