Mycotic False Aneurysm of the Aorta Following Aortic Valvular Prosthesis

A 39-year-old white man with acute rheumatic fever at the age of 19 years remained asymptomatic until 3 years before demise, when he started to have fainting episodes associated with chest pain and one year later symptoms of congestive heart failure. Examination at the Ohio State University Hospital showed signs of aortic stenosis, and cardiac catheterization revealed a pressure gradient of 90 mm. water across the aortic valve. He underwent open-heart surgery for the placement of a Starr-Edwards prosthetic valve in the aortic ostium. The postoperative course was complicated by anemia and wound infection with a coagulasepositive Staphylococcus but he responded to treatment fairly well. Four months after the operation the patient developed fatigue, occasional fever, and chills. One week before his last admission he noted petechiae, dyspnea, and orthopnea. Five months after the operation he was again admitted to University Hospital. On physical examination at this admission the patient was slightly dyspneic, the temperature was 100.2 F., and the blood pressure was 112/40. The neck veins were minimally distended at 300 position. The lungs revealed bilateral rales, particularly in the bases. The heart rate was regular at 87 per minute. The point of maximal impulse was in the sixth intercostal space at the left anterior axillary line. There were a grade-V/'VI holosystolic regurgitant murmur throughout the precordium radiating to the left axilla, a gradeIII/VI systolic ejection murmur in the right second intercostal space radiating toward the