Unicuspid Aortic Valve Presenting with Infectious Endocardit
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A 65-year-old man, who had no chest pain or symptoms of syncope, presented with a body temperature that had increased, for reasons unknown, to 38 °C. However, because of a blood culture positive for Streptococcus dysgalactiae, Infective Endocarditis was suspected.

A physical examination revealed conjunctival petechiae and Janeway lesions in his bilateral upper and lower extremities. Auscultation showed a significant systolic murmur (Levine III/VI), heard best at the second right upper sternal border and radiating to his neck, but no diastolic murmur.

Transesophageal echocardiography revealed a thick valve leaflet, a rounded vegetation with a diameter of 5 mm, a calcified surface, and border irregularity attached to the equivalent position of the aortic valve’s right coronary cusp, and mobility during diastole.

On the basis of a previous reports, a Unicuspid Aortic Valve, with a commissure at 12 o’clock and raphae at 4 o’clock and 8 o’clock, was confirmed. Owing to the fever spike and positive blood culture, he was admitted for further management of presumable IE with valvular heart disease.

Because of the uncontrolled infection, the aortic valve was urgently replaced with a Bioprosthetic valve. With appropriate antibiotic therapy for 6 weeks after surgery, he completely recovered from IE and was discharged.

Points worth Remembering:-
1. In general, UAVs are classified into two types: a unicommissural type with a single commissure and an acommissural type with an opening section in the center. The present case was of the unicommissural type with a commissure between the left coronary cusp and the noncoronary cusp.
2. In addition, the aortic insufficiency occurring in this case is a common complication of UAV, with aortic stenosis being the most common complication.

Source: https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-019-2239-9
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