J Cardiovasc Ultrasound.  2011 Sep;19(3):140-143. 10.4250/jcu.2011.19.3.140.

Complete Atrioventricular Block due to Infective Endocarditis of Bicuspid Aortic Valve

• Park MY
• Jeon HK
• Shim BJ
• Kim HN
• Lee HY
• Kang JH
• Kim JJ
• Koh YS
• Shin WS
• Lee JM

• KMID: 1980368
• DOI: http://doi.org/10.4250/jcu.2011.19.3.140

Abstract

A 38-year-old man visited our emergency department presenting with a 6-day persistent fever. The man had undergone an orthodontic procedure 7 days prior to the visit. He had a fever with a temperature of 38.2degrees C and a diastolic murmur (grade III) was detected at the left sternal border. Reddish-brown lines beneath the nails were present, and raised lesions which were red and painful were detected on the soles of the patient's feet. Laboratory findings showed an elevated inflammatory marker. Transthoracic and transesophageal echocardiograms, showed a bicuspid aortic valve, and moderate aortic regurgitation and vegetation were noted. Treatment with antibiotics was given, but 4 days later, a 12 lead electrocardiogram revealed complete atrioventricular (AV) block. Immediately, a temporary pacemaker was inserted, and the following day an aortic valve replacement was performed. Intraoperative findings revealed a fistula around the AV node. He has suffered no subsequent cardiac events during the follow-up.

Keyword

Endocarditis; Atrioventricular block; Aortic valve

MeSH Terms

Adult
Anti-Bacterial Agents
Aortic Valve
Aortic Valve Insufficiency
Atrioventricular Block
Atrioventricular Node
Bicuspid
Electrocardiography
Emergencies
Endocarditis
Fever
Fistula
Follow-Up Studies
Foot
Heart Murmurs
Heart Valve Diseases
Humans
Nails
Anti-Bacterial Agents
Aortic Valve
Heart Valve Diseases

Figure

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  Fig. 1 A: Reddish-brown lines beneath the nails. B and C: Painful red raised lesion on the soles of the feet.

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  Fig. 2 Transthoracic and transesophageal echocardiography. A: Moderate aortic regurgitation on apical view. B: The presence of vegetation (arrow) in the aortic valve tip on parasternal long axis view. C: Two leaflets seen in the aortic valve on a transesophageal echocardiogram. The vegetation (arrow) is seen in the left leaflet. D: The presence of vegetation (arrow) in the aortic valve tip on a transesophageal echocardiogram. The presence of aortic regurgitation seen on Doppler echocardiogram.

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  Fig. 3 Electrocardiogram. A: Electrocardiogram on hospital day 4: complete atrioventricular block. B: Electrocardiogram on post-op day 30: normal sinus rhythm.

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  Fig. 4 Intraoperative and surgical pathology finding. A: Intraoperative finding: the presence of a fistula (arrow) around the atrioventricular node below the left cusp. B: Surgical pathology finding: two leaflets seen in the aortic valve. A 1.5 × 1.3 cm sized vegetation seen in a leaflet.

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  Fig. 5 Microscopic finding. Histologic exam shows aortic valve leaflet vegetation with many inflammation cell and necrotic tissue (A, H&E stain 50×) (B, H&E stain 200×).

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