# Prosthetic Valve Endocarditis and Aortic Root Abscess: A Case of High-Risk Infection

## TL;DR

A 77-year-old man with a prosthetic aortic valve developed a life-threatening aortic root abscess, requiring urgent surgery and multidisciplinary care.

## Contribution

This case highlights the diagnostic and clinical challenges of prosthetic valve endocarditis and the importance of early surgical intervention.

## Key findings

- Multimodal imaging confirmed aortic root abscess in a patient with non-specific symptoms and persistent bacteremia.
- Successful aortic valve and root repair improved outcomes, though a pacemaker was required post-surgery.
- Heart block development illustrates the impact of aortic root abscess on cardiac conduction pathways.

## Abstract

Aortic root abscess is a severe complication of infective endocarditis (IE), particularly in patients with prosthetic valves, nearly doubling mortality risk. Due to the potential for rupture and systemic spread, urgent surgical intervention is recommended. We present the case of a 77-year-old man with a recent aortic valve replacement and a history of discitis who presented with non-specific symptoms, complete heart block, and persistent Staphylococcus epidermidis bacteremia. Multimodal imaging, including positron emission tomography (PET) and CT coronary angiography, confirmed an aortic root abscess. Following the IE multidisciplinary team (MDT) recommendations, the patient underwent successful aortic valve and root repair. Post-operatively, he required a pacemaker and dual antibiotic therapy for eight weeks, with no further infection detected. This case highlights the diagnostic challenges of prosthetic valve endocarditis, the critical role of multimodal imaging in detecting complications, and the necessity of early surgical intervention. The development of a heart block underscores the impact of aortic root abscess on conduction pathways. MDT management was essential in optimising patient outcomes.