Perforation of mitral-aortic intervalvular fibrosa secondary to bicuspid aortic valve endocarditis: Possible relation with diagnostic coronary angiography.

Infective endocarditis (IE) remains a serious and deadly disease despite recent advances in diagnosis and treatment. In all IE cases, the rate of healthcare-associated IE has been reported as 23%. Aortic valve endocarditis may extend to mitral-aortic intervalvular fibrosa (MAIVF), which may cause pseudoaneurysm formation and subsequent perforation. Direct perforation of the MAIVF is a rare clinical finding. In this report, we present a case of bicuspid aortic valve endocarditis which manifested as acute heart failure secondary to perforation of MAIVF and developed after diagnostic coronary angiography. <Learning objective: Direct perforation of MAIVF without abscess or aneurysm formation is a rare complication of IE. Health-care associated IE (HAIE) occurs mostly secondary to vascular manipulations and coronary angiography (CAG) is a rare cause of HAIE. Here, we report a case of aortic valve IE which developed two weeks after CAG and was complicated with perforation of MAIVF. Staphylococcus epidermidis was the causative microorganism. Urgent surgical treatment resulted in complete recovery of the patient.>.