Acute Aortic Regurgitation and Abscess of Sinus of Valsalva Due to Fulminating Ulcerative Endocarditis

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Abstract
Acute aortic regurgitation due to ulcerative endocarditis developed in 3 children aged 10, 6 and 7 years, respectively. All had congenital aortic valve lesions. Intractable congestive heart failure ensued about 2 weeks, 1 week, and a few days, respectively, after onset of infection. Two patients were operated on in the acute stage, and in both, perivalvular spread of the infection was found with abscess formation of the right sinus of Valsalva perforating through the interventricular septum to the right ventricle; valve replacement and repair were performed, but both patients died. The correct diagnosis was missed in the third patient, who was thought to have myocarditis and who died one week after onset of infection; at autopsy a perforation of a bicuspid aortic valve and an aneurysm of the sinus of Valsalva were found. The technical problems at operation are discussed. It is concluded that patients with congenital aortic valve lesions, who develop congestive heart failure in the course of a febrile disease, should be suspected of having acquired acute aortic regurgitation, and should be sent without delay for evaluation of indications for urgent surgery, before too extensive damage of the valve or perivalvular area has occurred.