A Systolic Murmur Late after Infective Endocarditis: Looking for the Guilty

Aortic location of infective endocarditis is a risk factor for perivalvular extension of infection, even when a native valve is involved. We report the case of a 50-year-old man with a systolic murmur and a history of previous aortic valve infective endocarditis requiring cardiac surgery. A thorough echocardiographic assessment, including three-dimensional transesophageal echocardiography, clearly demonstrated the presence of two distinct postinfective complications, i.e., a fistula of the mitral-aortic intervalvular curtain communicating in systole with the left atrium and an acquired Gerbode-type ventricular septal defect. Our case highlights the pivotal role of echocardiography for a correct and comprehensive diagnostic assessment in the complex scenarios frequently encountered after infective endocarditis.