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Image in Cardiology
Infective endocarditis complicated by aortic dissection and aorto-right ventricular fistula
Endocardite infecciosa complicada por disseção aórtica e por fístula entre o ventrículo direito e a aorta
Adriana Pereira
Autor para correspondência
adrianaicpereira@gmail.com

Corresponding author.
, Rui Pontes dos Santos, Nuno Moreno, Alexandra Castro, João Azevedo, Paula Pinto
Cardiology Department, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
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          2 => array:2 [
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        "titulo" => "Endocardite infecciosa complicada por disse&#231;&#227;o a&#243;rtica e por f&#237;stula entre o ventr&#237;culo direito e a aorta"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Transesophageal echocardiogram showing aortic valve endocarditis with perivalvular abscess and dilatation of the ascending aorta&#46; Ao&#58; ascending aorta&#59; LA&#58; left atrium&#59; LV&#58; left ventricle&#59; red arrow&#58; vegetations&#59; white arrow&#58; perivalvular abscess&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Infective endocarditis &#40;IE&#41; is a serious and complex disease with high morbidity and mortality&#46; Heart failure&#44; perivalvular extension and embolic events are well-known complications of IE&#46; By contrast&#44; the association of IE and acute aortic dissection &#40;AAD&#41; is extremely rare&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of an 83-year-old woman with hypertension&#44; atrial fibrillation and recent hospitalization due to complicated urinary tract infection&#44; who presented in the emergency department due to sudden depression of mental status&#46; On physical examination she presented confusion&#44; fever&#44; a harsh systolic aortic murmur with associated diastolic murmur and mild signs of congestive heart failure&#46; Head computed tomography revealed a recent ischemic area&#46; Transthoracic followed by transesophageal echocardiography revealed multiple sessile masses on the ventricular surface of a calcified bicuspid aortic valve&#44; compatible with vegetations&#59; moderate aortic regurgitation&#59; an image compatible with a perivalvular abscess&#59; and severe &#40;52 mm&#41; dilatation of the ascending aorta&#44; without intimal flap &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figures 1 and 2</a>&#44; Video 1&#41;&#46; Transthoracic and transesophageal echocardiograms were repeated on the third day due to development of acute pulmonary edema&#44; and revealed a de novo aortic dissection extending from the aortic root to the brachiocephalic trunk &#40;<a class="elsevierStyleCrossRefs" href="#fig0010">Figures 3 and 4</a>&#59; Videos 2 and 3&#41;&#44; and a fistula from the aortic root to the right ventricle &#40;Videos 4 and 5&#41;&#46; The patient was referred immediately for cardiac surgery but considered unsuitable due to mental status&#59; her clinical status deteriorated progressively culminating in death&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">In this case&#44; the patient presented with severe complications of IE&#46; Associated aortic dissection is uncommon&#44; with few cases described in the literature&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical disclosures</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of human and animal subjects</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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Informação do artigo
ISSN: 08702551
Idioma original: Inglês
DOI:10.1016/j.repc.2016.08.012
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