The infected heart: ventriculoseptal abscess and intracardiac fistulization

Infective endocarditis is a rare but potentially deadly infection of the endocardial layer, which can involve the valves of the heart among other structures. The extraordinarily rare complication seen in this case involves extensive damage manifesting in an aortic root abscess resulting in an abnormal communication between the aorta and the atrium known as an aortocavitary fistula (Eur Heart J 2005;26:288-297; Pediatr Cardiol 2011;32:1057-1059; J Am Coll Cardiol 1991;18:663-667). As the disease progresses, wading through the complex symptoms, which may seem unrelated, represents a key challenge in diagnosis. This case describes both early and late findings of endocarditis and highlights a rare complication in which rapid diagnosis and early surgical intervention before the development of hemodynamic sequelae are paramount. In this case, infective endocarditis, a great masquerader in this case, provided a challenging diagnostic situation, a very rare complication, and commonalities of disease characteristics that health care provider should appreciate.