Published online Feb 16, 2021. doi: 10.12998/wjcc.v9.i5.1221
Peer-review started: November 21, 2020
First decision: December 3, 2020
Revised: December 13, 2020
Accepted: December 24, 2020
Article in press: December 24, 2020
Published online: February 16, 2021
Infective endocarditis (IE) is an uncommon but potentially life-threatening infection, which occasionally develops into acute severe valve insufficiency leading to the onset of heart failure, and necessitates timely intervention. However, the variable and atypical clinical manifestations always make the early detection of IE difficult and challenging.
A 45-year-old female who was previously healthy presented with exertional shortness of breath and paroxysmal nocturnal dyspnea. She also suffered from a significant decrease in exercise capacity, whereas her body temperature was normal. She had severe hypoxemia and hypotension along with a marked aortic valve murmur. Diffuse pulmonary edema and bilateral pleural effusion were observed on both chest X-ray and computed tomography scan. Transthoracic echocardiography was performed immediately and revealed severe regurgitation of the bicuspid aortic valve. Transesophageal echocardiography was further performed and vegetations were detected. In addition to adequate medical therapy and ventilation support, the patient underwent urgent and successful aortic valve replacement. Her symptoms were significantly relieved and the postoperative chest X-ray showed that pulmonary edema was significantly reduced. Histopathology of the resected valve and positive microorganism culture of the surgical specimen provided evidence of definite IE.
IE should be considered in critical patients with refractory heart failure caused by severe bicuspid aortic valve regurgitation.
Core Tip: Infective endocarditis (IE) is a relatively rare disease with diverse clinical manifestations. We present herein, an uncommon case of bicuspid aortic valve endocarditis in a critically ill patient with acute heart failure, which was finally confirmed by histopathology and microorganism culture. Due to normal body temperature and lack of specific transthoracic echocardiography findings, prompt diagnosis of IE is difficult. This case highlights the importance of transesophageal echocardiography for the detection of vegetations, and IE should be considered especially in patients with severe aortic valve regurgitation and resistant heart failure.