Keywords
Tricuspid aortic valve
Aortic regurgitation
Aortic dissection
Aortic valve vegetations
Categories
How to Cite
Abstract
Infective endocarditis (IE) is a severe infection of the endocardial surface, most commonly affecting cardiac valves. Aortic dissection (AD) is a rare but life-threatening complication of IE. We report a case of IE with severe aortic regurgitation (AR) complicated by Type A AD in a tricuspid aortic valve, presenting without chest pain.
A 40-year-old male with no comorbidities presented with intermittent low-grade fever for 4 months and progressive dyspnea for 5 days. Examination revealed blood pressure discrepancy (90/60 mmHg right arm, 110/70 mmHg left arm) and a diastolic murmur. Laboratory tests showed a WBC count of 15,000/µL, a CRP level of 15 mg/L, an ESR of 28 mm/hr, and a troponin level of 540 ng/L. Transthoracic echocardiography demonstrated a thickened tricuspid aortic valve with large vegetations, severe AR, and an intimal flap consistent with Type A AD. Blood cultures grew Streptococcus viridans. The patient received intravenous Penicillin G and Gentamicin for 2 weeks and underwent emergent surgical repair.
The coexistence of IE and AD is extremely rare, particularly in patients without bicuspid aortic valve or connective tissue disorders. Proposed mechanisms include microbial invasion of the aortic wall and hemodynamic stress from severe AR. This case underscores the importance of maintaining a high index of suspicion for AD in IE patients, even in the absence of chest pain. Early echocardiographic evaluation, rapid surgical intervention, and culture-directed antibiotics are critical for survival in IE complicated by AD.
References
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