Disastrous course of recurrent infective endocarditis after tooth extraction in a young patient with bicuspid aortic valve.

In a patient with moderate malformations of the left-ventricular valves disregard of antibiotic prophylaxis after tooth extraction resulted in massive mitral- and aortic regurgitation. After surgical reconstruction a relapse produced an aorto left-ventricular fistula with septic embolizations and cardiac decompensation. Valve replacement with a homograft reconstituted the hemodynamic situation. During both episodes the Duke criteria for infective endocarditis supported the diagnosis.