A 75-year-old woman with a bioprosthetic aortic valve, who had undergone surgical repair of an aortic root aneurysm 9 months earlier was hospitalized with fever, headache, and altered mental status of 1-day's duration.
Drs Subbarao Elapavaluru, Gamil Kostandy, Mithilesh Das, and Majesh Makan of the division of cardiology, department of medicine at New York Methodist Hospital in Brooklyn report that blood cultures were positive for Enterococcus faecalis. Transesophageal echocardiography was performed on admission. Both the transverse view (A) and the longitudinal view (B) of the heart reveal an extensive abscess at the beginning of the aortic root (small arrow) near the aortic valve.
The abscess extends to the aortic mitral anulus fibrosus and is seen here as a mass in the atrial side of the anterior mitral leaflet (large arrow).
Five days after admission, the left sinus of Valsalva ruptured into the left atrium with continuous shunt (aortic-left atrial fistula). The patient died during surgery to repair the fistula and the aortic root abscess.