Megan Zilla, MD and Jeffrey Nine, MD
A male in his 50s with a history of bioprosthetic aortic valve replacement and coronary artery bypass graft presented after being found unconscious at home. His blood cultures grew Streptococcus Viridans group and intravenous antibiotics were initiated. A transesophageal echocardiogram showed an aortic valve vegetation and moderate aortic regurgitation without overt findings of an aortic root abscess. Several days later he became acutely short of breath, his mean arterial pressures dropped from about 130 to 40s-50s, and he became bradycardic. Resuscitation efforts began and a repeat transesophageal echocardiogram performed during these efforts showed right sided aortic annular echolucency on the right ventricle/tricuspid valve side of the aortic root with possible fistula formation. Unfortunately he suffered PEA arrest and was pronounced deceased after advanced cardiac life support failed to resuscitate him. A hospital autopsy was performed.