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Staphylococcus Aureus Endocarditis Complicated by Aortic Root Abscess, Coronary Fistula, and Mitral Valve Perforation
Journal of the American College of Cardiology © 2012 by the American College of Cardiology Foundation Published by Elsevier Inc.
Vol. 59, No. 16, 2012 ISSN 0735-1097/$36.00 doi:10.1016/j.jacc.2011.06.086
IMAGES IN CARDIOLOGY
Staphylococcus Aureus Endocarditis Complicated by Aortic Root Abscess, Coronary Fistula, and Mitral Valve Perforation Lee Fong Ling, MBBS,*† Andrew C. Y. To, MBCHB,* Venugopal Menon, MD* Cleveland, Ohio; and Singapore
From the *Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; and the †Department of Cardiology, KTPH, Alexandra Health, Singapore. Manuscript received June 9, 2011; accepted June 16, 2011.
A
62-year-old man with recurrent Staphylococcus aureus endocarditis in the setting of previous mechanical aortic valve replacement, coronary artery bypass graft, and multiple comorbidities was transferred to our institution for further care. A transesophageal echocardiogram demonstrated a large posterior aortic root abscess (*) with a septate cavity that extended into the mitral aortic intervalvular fibrosa (A and B, Online Videos 1 and 2). Color flow Doppler showed communication between the abscess cavity, left atrium, and left ventricle outflow tract (C). A large perforation (blue arrow) at the base of the anterior mitral valve resulted in severe eccentric posterolaterally directed mitral regurgitation (C, Online Video 3). Coronary angiography revealed a fistula from the mid left main trunk with flow directed into the abscess cavity (D, Online Video 4). Computed tomography (E) demonstrated this 5 ⫻ 4 ⫻ 3-cm periaortic abscess (red arrow) completely surrounding the left main trunk and proximal circumflex artery (orange arrow), which are outlined by coronary calcifications. He was deemed a poor surgical candidate and was discharged with home hospice care. Ao ⫽ aorta; LA ⫽ left atrium; LAO ⫽ left anterior oblique; LV ⫽ left ventricle; RA ⫽ right atrium; RV ⫽ right ventricle.
Vol. 59, No. 16, 2012 ISSN 0735-1097/$36.00 doi:10.1016/j.jacc.2011.06.086
IMAGES IN CARDIOLOGY
Staphylococcus Aureus Endocarditis Complicated by Aortic Root Abscess, Coronary Fistula, and Mitral Valve Perforation Lee Fong Ling, MBBS,*† Andrew C. Y. To, MBCHB,* Venugopal Menon, MD* Cleveland, Ohio; and Singapore
From the *Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; and the †Department of Cardiology, KTPH, Alexandra Health, Singapore. Manuscript received June 9, 2011; accepted June 16, 2011.
A
62-year-old man with recurrent Staphylococcus aureus endocarditis in the setting of previous mechanical aortic valve replacement, coronary artery bypass graft, and multiple comorbidities was transferred to our institution for further care. A transesophageal echocardiogram demonstrated a large posterior aortic root abscess (*) with a septate cavity that extended into the mitral aortic intervalvular fibrosa (A and B, Online Videos 1 and 2). Color flow Doppler showed communication between the abscess cavity, left atrium, and left ventricle outflow tract (C). A large perforation (blue arrow) at the base of the anterior mitral valve resulted in severe eccentric posterolaterally directed mitral regurgitation (C, Online Video 3). Coronary angiography revealed a fistula from the mid left main trunk with flow directed into the abscess cavity (D, Online Video 4). Computed tomography (E) demonstrated this 5 ⫻ 4 ⫻ 3-cm periaortic abscess (red arrow) completely surrounding the left main trunk and proximal circumflex artery (orange arrow), which are outlined by coronary calcifications. He was deemed a poor surgical candidate and was discharged with home hospice care. Ao ⫽ aorta; LA ⫽ left atrium; LAO ⫽ left anterior oblique; LV ⫽ left ventricle; RA ⫽ right atrium; RV ⫽ right ventricle.