Significant PR Prolongation and New Onset Left Bundle Branch Block in Aortic Root Abscess: A Marker of Disease Progression and Poor Prognosis

BACKGROUND Patients with a bicuspid aortic valve have increased risk of infective endocarditis, but common organisms are not always the culprit. We describe a case of an otherwise healthy young gentleman with bicuspid aortic valve who experienced Abiotrophia defectiva (A. defectiva) endocarditis. The aim of this case report is to highlight an uncommon cause of endocarditis associated with significant morbidity and mortality in order to improve the care provided by trainees and clinicians. CASE SUMMARY A 37-year-old male presented with a 1-month history of fever, weight loss, myalgia, and night sweats. On transesophageal echocardiography (TOE), he was found to have a bicuspid aortic valve with large vegetation and severe aortic insufficiency. Blood cultures were positive for A. defectiva. The endocarditis was successfully treated with surgical aortic valve replacement and six weeks of antibiotic therapy. DISCUSSION Bicuspid valves are known to have increased susceptibility to endocarditis. The difficulty of isolating A. defectiva typically leads to delayed diagnosis and significant complications. This case is a reminder to have a high degree of suspicion for organisms which are rare and difficult to isolate because prompt recognition and surgical intervention may improve the outcome of care.

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PR interval prolongation is significantly associated with aortic root abscess: An age‐ and gender‐matched study

Kohli

Obuobi

Addetia

et al. 2021

Noninvasive Electrocardiol

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Background: Electrocardiographic abnormalities, such as PR interval prolongation, havebeenanecdotallyreportedinpatientswithaorticrootabscess(ARA).Anelectrocardiographic marker may be useful in identifying those patients with aortic valve endocarditiswhomayprogresstoARA.Theobjectiveofthisstudyistoevaluatethe changeinthePRintervalinpatientswithsurgicallyconfirmedARAandcompareit to age-and gender-matched controls with echocardiographically or surgically confirmed aortic valve endocarditis but without aortic root abscess and those hospitalized with diagnoses other than endocarditis. Methods: Patients were eligible for enrollment if they were 18 years or older and were hospitalizedforeitherARA,aorticvalveendocarditis,orforunrelatedreasonsandhad atleastone12-leadelectrocardiogram(ECG)priortooronthedayofhospitalization andatleastoneECGafterhospitalizationbutpriortoanycardiacsurgicalprocedure. DeltaPRinterval,definedasthedifferencebetweenthepre-andpost-admissionPR interval,wastheprimaryoutcomeofinterest.ThepatientsintheARAgroupwereageandgender-matchedtopatientswithaorticvalveendocarditisandtothosewithoutendocarditis. Comparisons of demographic variables and study outcomes were performed. Results: EighteenpatientswithsurgicallyconfirmedARAwereenrolled.Thesepatients wereage-andgender-matchedto19patientswithaorticvalveendocarditisand18patientswithnopasthistoryorevidenceofendocarditisduringhospitalization.Nodiffer-encewasnotedinthebaselinePRintervalbetweenthegroups.However,thePRintervalfollowing admission in the aortic root abscess group (201 ±66ms)wassignificantlylonger than the PR interval in both the aortic valve endocarditis (162 ±27ms)(24%,p =.009) andnoendocarditis(143±24ms)(40%,p <.001)groups.Theprimaryoutcomemeasure, deltaPRinterval,wassignificantlylongerintheARAgroup(35±51ms)thannoendocarditis(−5±17ms)(p =.001)andaorticvalveendocarditisgroups(0.2±18)(p =.003). Conclusions:The findings of our study support the notion that the PR interval is morelikelytobeprolongedinpatientswithARA.SinceARAisassociatedwithahigh morbidityandmortality,PRintervalprolongationinapatientwithaorticvalveendocarditis should prompt a thorough evaluation for aortic root involvement.

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Significant PR Prolongation and New Onset Left Bundle Branch Block in Aortic Root Abscess: A Marker of Disease Progression and Poor Prognosis

Cited by 3 publications

References 14 publications

Cardiovascular Infection

Cardiovascular Infection

Abiotrophia defectiva endocarditis of bicuspid aortic valve: a case report

PR interval prolongation is significantly associated with aortic root abscess: An age‐ and gender‐matched study

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