Periaortic Valve Abscess Presenting as Unstable Angina
An 82-year-old woman admitted to hospital for endocarditis caused by Staphylococcus aureus presented, after medical treatment, some episodes of angina. Echocardiography showed a mitroaortic junction abscess communicating with the left ventricle (Figures 1 and 2⇓).
Angina became unstable, with marked ST-segment depression not responding to treatment. Coronary ischemia in endocarditis is generally due to preexisting coronary disease or occasionally is a result of embolism from vegetations. Coronary angiography showed a severe long stenosis of the left main trunk in systole in the presence of normal distal vessels (Figure 3). In diastole, the whole coronary tree was normal (Figure 4), suggesting an extrinsic coronary compression.
Emergency surgery confirmed the presence of a periaortic cavity in the mitroaortic junction (Figure 5), residual of an abscess, that was closed with a Dacron patch.
Postoperative stay was complicated by acute renal failure; the patient was discharged after 19 days. A 3-month follow-up showed a restored good quality of life.
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