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Asian Cardiovasc Thorac Ann 2003;11:275
© 2003 Asia Publishing EXchange Ltd

IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY

An Unusual Late Complication of Infective Endocarditis

On-Hing Kwok, FACC, Wing-Hing Chow, FRCP, David LC Cheung, FRCS1

Division of Cardiology, University Department of Medicine
1 Division of Cardiothoracic Surgery, University Department of Surgery, Grantham Hospital, Hong Kong, People’s Republic of China

For reprint information contact: On-Hing Kwok, FACC Tel: 852 2518 2611 Fax: 852 2518 8558 email: vohkwok{at}netvigator.com 5/F Kwok Tak Seng Heart Center, Grantham Hospital, 125 Wong Chuk Hang Road, Aberdeen, Hong Kong, People’s Republic of China.



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  		Figure 1.
 
A 44 year-old man underwent emergent aortic valve replacement for decompensated heart failure. This was a result of a severe aortic regurgitation, a complication of Streptococcus agalactiae infective endocarditis 6 weeks prior. The patient presented with an acute coronary syndrome while receiving intravenous antibiotic treatment in a convalescence hospital. A coronary angiogram revealed a critical left main coronary artery stenosis (Panel B). A digital subtraction aortogram revealed extravasation of contrast from the left sinus of Valsalva into an abscess cavity, causing extrinsic compression of the left main coronary artery (Panel A). Emergent surgical exploration confirmed the diagnosis. The patient underwent surgical excision of the abscess with patch repair of the sinus of Valsalva and revascularization of the left coronary arteries using saphenous vein grafts. Recovery was uneventful. Aortic root abscess causing left main compression and acute coronary syndrome is a very unusual complication of infective endocarditis. Early cardiac catheterization and digital subtraction angiography could help to define the coronary anatomy and confirm the diagnosis in a safe and accurate manner.





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