QUADRICUSPID AORTIC VALVE ENDOCARDITIS WITH EMBOLIC STROKE

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Quadricuspid aortic valve (QAV) is a very rare congenital cardiac anomaly with an incidence of 0.05-1%. Inevitably, patients QAV are at increased risk infective endocarditis. The main structural sequela predominantly regurgitant (aortic insufficiency). Approximately 1 in 5 cases require surgical intervention and tricuspidalization preferred technique for repair. Decision making repair critical. Here we present case recurrent endocarditis patient after dental procedure. CASE PRESENTATION: A 60 year-old female history recent abscess tooth extraction presented from outside hospital (OSH) persistent fevers malaise. At OSH she was being treated suspected pyelonephritis. She transferred to our facility developing sudden onset left upper extremity weakness MRI revealing multiple areas cortical venous infarcts thrombosis. On admission facility, noted have ischemic distal phalange non-tender palmar lesions (Fig 1). Blood cultures grew methicillin-susceptible staphylococcus aureus. With concern septic emboli, transthoracic echocardiogram (TTE) showed thickened mobile vegetation, mild central regurgitation, persevered ejection fraction. Cardiothoracic surgery determined not candidate given large distribution embolic stroke six weeks IV antibiotics. Seven discharge readmitted fevers, sepsis. TTE revealed severe insufficiency transesophageal demonstrated insufficiency, mass on right coronary cusp. identified annular proceeded debridement root. DISCUSSION: current AATS guidelines indications include dysfunction, invasion beyond the leaflets, systemic embolization, among others. emphasize that once indication established, cardiothoracic should be performed as soon possible. timing strokes remains area discussion. Current literature reflects shift towards earlier intervention, however decision individualized severity consideration. Although this met surgery, her burden, preserved function, clinical improvement antibiotics, made prolong course antibiotic therapy until surgery. CONCLUSIONS: This presents example complex multidisciplinary approach treatment intervention. REFERENCE #1: Pettersson GB, Hussain ST. Ann Cardiothorac Surg. 2019;8(6):630-644. doi:10.21037/acs.2019.10.05 #2: Yuan S. M. (2016). Aortic Valve: Comprehensive Review. Brazilian journal cardiovascular 31(6), 454–460. https://doi.org/10.5935/1678-9741.20160090 #3: Ryosuke Murai, MD, Shunsuke Funakoshi, Shuichiro Kaji, PhD, Takeshi Kitai, Kitae Kim, Tadaaki Koyama, b Yutaka Furukawa, PhDa DISCLOSURES: No relevant relationships by Vanessa Hoytfox, source=Web Response Cicily Hummer,