Journal of Cardiovascular Imaging

Korean Society of Echocardiography (한국심초음파학회)
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COMPLETE ATRIOVENTRICULAR BLOCK DUE TO INFECTIVE ENDOCARDITIS OF BICUSPID AORTIC VALVE

  • Park, Mi-Youn (Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea School of Medicine) ;
  • Jeon, Hui-Kyung (Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea School of Medicine) ;
  • Shim, Byung-Ju (Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea School of Medicine) ;
  • Kim, Ha-Neul (Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea School of Medicine) ;
  • Lee, Hye-Yeon (Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea School of Medicine) ;
  • Kang, Ju-Hyun (Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea School of Medicine) ;
  • Kim, Jin-Jin (Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea School of Medicine) ;
  • Koh, Yoon-Seok (Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea School of Medicine) ;
  • Shin, Woo-Seung (Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea School of Medicine) ;
  • Lee, Jong-Min (Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea School of Medicine)
  • Published : 2011.09.27
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Abstract

A 38-year-old man visited our emergency department presenting with a 6-day persistent fever. The man had undergone an orthodontic procedure 7 days prior to the visit. He had a fever with a temperature of $38.2{^{\circ}C}$ and a diastolic murmur (grade III) was detected at the left sternal border. Reddish-brown lines beneath the nails were present, and raised lesions which were red and painful were detected on the soles of the patient's feet. Laboratory findings showed an elevated inflammatory marker. Transthoracic and transesophageal echocardiograms, showed a bicuspid aortic valve, and moderate aortic regurgitation and vegetation were noted. Treatment with antibiotics was given, but 4 days later, a 12 lead electrocardiogram revealed complete atrioventricular (AV) block. Immediately, a temporary pacemaker was inserted, and the following day an aortic valve replacement was performed. Intraoperative findings revealed a fistula around the AV node. He has suffered no subsequent cardiac events during the follow-up.

Keywords

References

  1. Yener N, Oktar GL, Erer D, Yardimci MM, Yener A. Bicuspid aortic valve. Ann Thorac Cardiovasc Surg 2002;8:264-7.
  2. Knosalla C, Weng Y, Yankah AC, Siniawski H, Hofmeister J, Hammerschmidt R, Loebe M, Hetzer R. Surgical treatment of active infective aortic valve endocarditis with associated periannular abscess--11 year results. Eur Heart J 2000;21:490-7.
  3. Ward C. Clinical significance of the bicuspid aortic valve. Heart 2000;83:81-5. https://doi.org/10.1136/heart.83.1.81
  4. Kahveci G, Bayrak F, Pala S, Mutlu B. Impact of bicuspid aortic valve on complications and death in infective endocarditis of native aortic valves. Tex Heart Inst J 2009;36:111-6.
  5. Siu SC, Silversides CK. Bicuspid aortic valve disease. J Am Coll Cardiol 2010;55:2789-800.
  6. Lamas CC, Eykyn SJ. Bicuspid aortic valve--A silent danger: analysis of 50 cases of infective endocarditis. Clin Infect Dis 2000;30:336-41.
  7. Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, Levison M, Bolger A, Cabell CH, Takahashi M, Baltimore RS, Newburger JW, Strom BL, Tani LY, Gerber M, Bonow RO, Pallasch T, Shulman ST, Rowley AH, Burns JC, Ferrieri P, Gardner T, Goff D, Durack DT; American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee; American Heart Association Council on Cardiovascular Disease in the Young; American Heart Association Council on Clinical Cardiology; American Heart Association Council on Cardiovascular Surgery and Anesthesia; Quality of Care and Outcomes Research Interdisciplinary Working Group. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 2007;116:1736-54.
  8. Graupner C, Vilacosta I, SanRoman J, Ronderos R, Sarria C, Fernandez C, Mujica R, Sanz O, Sanmartin JV, Pinto AG. Periannular extension of infective endocarditis. J Am Coll Cardiol 2002;39:1204-11.
  9. Arnett EN, Roberts WC. Valve ring abscess in active infective endocarditis. Frequency, location, and clues to clinical diagnosis from the study of 95 necropsy patients. Circulation 1976;54:140-5.
  10. Bacchion F, Cukon S, Rizzoli G, Gerosa G, Daliento L, Thiene G, Basso C. Infective endocarditis in bicuspid aortic valve: atrioventricular block as sign of perivalvular abscess. Cardiovasc Pathol 2007;16:252-5.

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  1. Infective Endocarditis Presenting as Complete Heart Block With an Unexpected Finding of a Cardiac Abscess and Purulent Pericarditis vol.7, pp.11, 2015, https://doi.org/10.14740/jocmr2228w