Abscess, aneurysm, fistula, and complete AV block in infective endocarditis of the aortic valve

Excerpt

Infective endocarditis (IE) in chronic hemodialysis (HD) patients is significantly more common and causes a greater risk of morbidity and mortality than in the general population [1]. There are certain clinical and echocardiographic factors identified as having a prognostic role for early and late mortality among HD patients with IE [1, 2]. Transthoracic (TTE) and transesophageal echocardiography (TEE) play a key role in evaluating the perivalvular dissemination of IE and guiding management [1, 2, 3, 4]. We present the case of a 78-year-old male HD patient who was examined for presyncope during hemodialysis. A pacemaker was implanted because of complete AV block. During follow-up, TTE demonstrated a mass of indistinguishable origin in the left atrium. TEE showed that this mass was caused by an abscess, an aneurysm, and a fistula formation. Each of these findings—abscess, aneurysm, fistula, and complete AV block— is a warning of imminent death; therefore, in this case report, we highlight the clinical and echocardiographic determination of perivalvular dissemination in IE. …