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A Journal on Surgery

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Chirurgia 2010 December;23(6):261-6

language: English

Infective endocarditis of native aortic valve: destruction of leaflet with an aorto-cavitary fistula to the right ventricle

Velicki L. 1, Susak S. 1, Srdanovic I. 2, Kovacevic M. 2

1 Clinic for Cardiovascular Surgery, Institute of Cardiovascular Diseases of Vojvodina, Novi Sad, Serbia
2 Clinic for Cardiology, Institute of Cardiovascular Diseases of Vojvodina, Novi Sad, Serbia


Infective endocarditis is an endovascular microbial infection of cardiovascular structures, including large intrathoracic vessels and intracardiac foreign bodies. In case of periannular tissue involvement results could be catastrophic. Periannular abscess rupture leads to aorto-cavitary fistula formation with subsequent intracardiac shunting which furthermore overloads the heart progressively leading to heart failure. This complication must be timely recognized and surgically treated. Transesophageal echocardiography presents highly accurate imaging tool capable of detecting endocarditis and its complications even in the absence of positive blood cultures. Staphylococcus aureus, Streptococcus viridians groups A, C and G and Enterococcus species are the most common microorganisms that cause infective endocarditis. Several surgical techniques have been proposed for treating native valve endocarditis including valve repair or replacement, drainage of abscess cavities, the excision of necrotic tissue and the closure of aorto-cavitary fistula. We present a case of native valve endocarditis caused by Enterococcus spp. with a partial disruption of right coronary valve, two large periannular abscesses and aorto-cavitary fistula to the right ventricle.

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