SHM Converge Scientific Abstract ePoster Gallery-Infective Endocarditis Complicated by Intracardiac Fistula and Systemic Embolization

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This case describes a 29-year-old man with type 1 diabetes and a chronic nonhealing foot wound who presented with dyspnea and malaise. He was found to have methicillin-sensitive Staphylococcus aureus bacteremia and infective endocarditis involving both the mitral and tricuspid valves. His presentation included a new holosystolic murmur, leukocytosis, hyperglycemia, and complete heart block, suggesting conduction system involvement.<br /><br />Initial transthoracic and transesophageal echocardiography showed vegetations with extension into the basal interventricular septum and abscess formation, with early aortic annular involvement. During hospitalization, he developed confusion and right-sided weakness. Imaging revealed multiple septic emboli: ischemic infarcts in the brain, septic pulmonary emboli, and infarcts in the spleen and both kidneys.<br /><br />Despite antibiotic therapy, his condition worsened with symptomatic bradycardia. Repeat echocardiography demonstrated progression to perforation of the anterior mitral annulus and formation of a left-to-right intracardiac shunt between the left ventricular outflow tract and right atrium, consistent with a fistula.<br /><br />He underwent urgent cardiothoracic surgery with bioprosthetic mitral valve replacement, tricuspid valve repair, fistula patch repair, and permanent dual-chamber pacemaker placement. He recovered well postoperatively and completed six weeks of intravenous antibiotics.<br /><br />The report emphasizes that infective endocarditis complicated by periannular abscess, fistula formation, conduction abnormalities, and systemic embolization carries high risk and often requires early surgical intervention. It highlights the importance of prompt recognition and surgical referral when valvular complications are present.

Asset Subtitle

Abu Hurera

Meta Tag

Author List Abu Hurera, Bhawna Agarwal, Noor Ul Ain

Category Clinical Vignettes

Concept Infective Endocarditis

Concept Periannular Abscess

Concept Intracardiac Fistula

Concept Systemic Septic Embolization

Concept Echocardiography

Distinguished Non-Finalist

Presenter Organization UPMC McKeesport

Presenting Author Abu Hurera

Track Adult

Keywords

infective endocarditis

Staphylococcus aureus bacteremia

mitral valve

tricuspid valve

periannular abscess

conduction block

septic emboli

intracardiac fistula

valve replacement

surgical intervention

Infective Endocarditis

Periannular Abscess

Intracardiac Fistula

Systemic Septic Embolization

Echocardiography