Perivalvular Mitral Abscess Fistulised to the Pericardial Cavity Revealing Staphylococcal Endocarditis

Heart Lung Circ. 2018 Mar;27(3):e34-e37. doi: 10.1016/j.hlc.2017.10.013. Epub 2017 Oct 31.

Abstract

Background: Fistula to the pericardial cavity is a very rare complication of perivalvular abscess during infective endocarditis, with Staphylococcus aureus being the most commonly associated microorganism.

Methods: We report a fatal septic shock due to a mitral endocarditis revealed by a myocardial abscess fistulised toward the pericardial cavity.

Results: A 66-year-old female without previous valvular disease was admitted to intensive care for severe sepsis. A few hours after admission, an unexpected cardiac arrest occurred. Chest computed tomographic-scan and transoesophageal echocardiography revealed a pericardial effusion due to a perivalvular mitral abscess fistulised toward the pericardial cavity. Despite prompt management including surgical debridement and appropriate antibiotics, death occurred 36hours after intensive care admission. All blood cultures as well as native mitral valve and pericardial fluid grew methicillin-sensitive Staphylococcus aureus.

Conclusions: Intensivists should consider this rare complication in patients with staphylococcal infective endocarditis and perivalvular abscess.

Keywords: Infective endocarditis; Myocardial fistula; Pericarditis; Perivalvular abscess; Staphylococcus aureus.

Publication types

  • Case Reports

MeSH terms

  • Abscess / complications
  • Abscess / diagnosis*
  • Abscess / microbiology
  • Aged
  • Echocardiography
  • Endocarditis, Bacterial / complications
  • Endocarditis, Bacterial / diagnosis*
  • Endocarditis, Bacterial / microbiology
  • Female
  • Humans
  • Mitral Valve / diagnostic imaging*
  • Mitral Valve / microbiology
  • Pericardial Effusion / diagnosis
  • Pericardial Effusion / etiology*
  • Pericardial Effusion / microbiology
  • Pericardium
  • Staphylococcal Infections / complications
  • Staphylococcal Infections / diagnosis*
  • Staphylococcal Infections / microbiology
  • Staphylococcus aureus / isolation & purification*
  • Tomography, X-Ray Computed