The Role of Multimodal Imaging in a Case if Infective Endocarditis . . . with Surprises and Happy Ending

Abstract Infective endocarditis, a potentially fatal condition and a serious public health problem can be difficult to diagnose due to non-specific symptoms. Thus, the multidisciplinary approach to this pathology by the Endocarditis Team is essential for optimizing management and reducing mortality. Echocardiography is the main way to diagnose an infective endocarditis. Coronary CT angiogram is an alternative to invasive coronary angiography for the preoperative evaluation of the coronary status in patients with aortic valve affected by the infectious process. We hereby present the case of a 45-year-old patient known with a bicuspid aortic valve, diagnosed with mitral valve and aortic valve infective endocarditis, complicated with valvular ruptures and severe bivalvular regurgitation 5 months after the onset of an intermittent febrile syndrome, identified and treated as bronchopneumonia in another hospital. Methods Multimodal imaging helps to confirm the diagnosis. Echocardiography, both transthoracic and transesophageal, is the main diagnostic method. Coronary CT angiogram reveals severe bicoronary lesions with "high risk" atheroma plaques. Results After a complex double valve replacement with mechanical prostheses, two aortocoronary bypass and prosthetic aortic replacement of the ascending thoracic aorta, the result was excellent and the patient was discharged without clinical symptoms of heart failure at rest and during exertion. At the 1-month postoperative follow-up the patient had no symptoms and the transthoracic echocardiography showed the improvement of the systolic dysfunction of the left ventricle. Conclusions Multimodal imaging plays an extremely important role in the diagnosis of infective endocarditis and associated pathologies. Although the surgical risk is very high in this type of interventions, the patients can well overcome the operative moment and can be quickly socio-professionally reintegrated. The multidisciplinary evaluation of these complex patients is mandatory to find the best management strategy for such cases.