Natural progression of non-surgically managed infective endocarditis

We present various echocardiograms which closely follow the progression the infective endocarditis in a patient with previous cardiac surgery and prosthetic material in situ.A 51 year old gentleman presented presented with complaints of fevers and gastrointestinal infective symptoms in the context of previously having undergone an aortic root replacement and metallic aortic valve implantation several years prior for a previous episode of aortic dissection whilst utilising illicit intravenous drug use.Echocardiography noted an aortic valve vegetation and blood cultures grew non typhoidal Salmonella Typhimurium. A surgical opinion deemed he was not an appropriate candidate for surgical intervention due to tissue friability and continuous intravenous drug use. Serial echocardiograms show the formation of an aortic root abscess, which fistulised between the left ventricle, right ventricle and right atrium. His clinical condition stabilised and was discharged from hospital with close community monitoring and life-long antibiotic therapy.This case depicts the remarkable images surrounding the natural progression of infective endocarditis managed without surgical intervention, together with the difficulties and limitations in managing prosthetic valve endocarditis.
Source: Journal of Indian College of Cardiology - Category: Cardiology Source Type: research