Bicuspid aortic valve, a silent danger predisposing to native triple valve Staphylococcus epidermidis endocarditis in a middle-aged man: a case report

Abstract Background Bicuspid aortic valves are the commonest congenital heart defects. Staphylococcus epidermidis is part of the normal human flora and is often considered a culture contaminant but is emerging as a major pathogen in nosocomial infections. Case summary We report this case of a 58 year-old man with severe bicuspid aortic stenosis who had four positive blood cultures with S. epidermidis . No abscess or mural thickening was visualised on a CT aorta. However, an intra-operative trans-oesophageal echocardiography identified vegetations on the aortic valve extending to the mitral valve, an aortic root abscess with a fistula communicating with the right atrium and a large vegetation on the tricuspid annulus. He was started on appropriate antimicrobial therapy and underwent a mechanical aortic valve replacement, closure of shunt and only debridement of the mitral and tricuspid valves. Discussion We present an uncommon case of a middle-aged man with a common congenital defect of bicuspid aortic valves that was the intrinsic cardiac predisposition to the subsequent development of triple valve endocarditis. He underwent emergent cardiac surgery and survived with minimal sequelae.