We present a case of aortic and mitral valve endocarditis caused by Streptococcus gallolyticus, probably with a gastrointestinal point of entry, complicated with acute heart failure, mitral valve leaflet abscess and intervalvular fibrosa abscess, that required urgent surgery.
After aortic vegetation and MAIVF excision (intraoperative diagnosis of intervalvular fibrosa abscess), double replacement of aortic and mitral valve was performed with bileaflet mechanical prosthesis.
Despite the multitude of complications this patient had, antibiotics-induced acute kidney injury, peripheral embolism, mitral and intervalvular fibrosa abscesses, acute pulmonary edema from transfusions, gastrointestinal bleeding, prosthesis endocarditis and secondary aortic prosthesis dehiscence, he somehow managed to survive.
CTA revealed an eight-millimeter mycotic aneurysm of the aortic annulus extending into the intervalvular fibrosa and no residual aortic valve vegetation (Figure 4).
Caption: Figure 4: Multiplanar, reformatted oblique views of cardiac CTA (a, b, c) demonstrating the small pseudoaneurysm * involving the aortic annulus and the mitral-aortic intervalvular fibrosa.
In this procedure, all of the organisms' moist tissues were extracted and homogenized together with intervalvular
Approximately 150 oysters and their intervalvular liquor were studied.
The Vibrio Standard Plate Counts (SPC) from the oysters and their intervalvular liquor varied from 25 to 59,000,000 CFU/g (Table 1).
The pH of oysters' meat plus the intervalvular liquor varied from 6.
Mussels and barnacles feed in this way, and when exposed at low tide they remain immersed for long periods in their own intervalvular
water, exhausting its oxygen and food.