Infective bicuspid aortic valve endocarditis causing acute severe regurgitation and heart failure: A case report

BACKGROUND: Infective endocarditis (IE) is an uncommon but potentially life-threatening infection, which occasionally develops into acute severe valve insufficiency leading to the onset of heart failure, and necessitates timely intervention. However, the variable and atypical clinical manifestations always make the early detection of IE difficult and challenging. CASE SUMMARY: A 45-year-old female who was previously healthy presented with exertional shortness of breath and paroxysmal nocturnal dyspnea. She also suffered from a significant decrease in exercise capacity, whereas her body temperature was normal. She had severe hypoxemia and hypotension along with a marked aortic valve murmur. Diffuse pulmonary edema and bilateral pleural effusion were observed on both chest X-ray and computed tomography scan. Transthoracic echocardiography was performed immediately and revealed severe regurgitation of the bicuspid aortic valve. Transesophageal echocardiography was further performed and vegetations were detected. In addition to adequate medical therapy and ventilation support, the patient underwent urgent and successful aortic valve replacement. Her symptoms were significantly relieved and the postoperative chest X-ray showed that pulmonary edema was significantly reduced. Histopathology of the resected valve and positive microorganism culture of the surgical specimen provided evidence of definite IE. CONCLUSION: IE should be considered in critical patients with refractory heart failure caused by severe bicuspid aortic valve regurgitation.