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September 15, 2026European Heart Journal Supplements

From Conduction Delay to Complete Block: Annular Abcsess in Prosthetic Aortic Valve

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Key result

Urgent redo AVR with annular debridement restores sinus rhythm in endocarditis with complete AV block.

  • n=1

Why the study?

Periannular extension with abscess formation in prosthetic valve endocarditis is a severe complication that can cause atrioventricular conduction disturbances, often requiring urgent surgical management.

Population

A 75-year-old man with a bioprosthetic aortic valve and prosthetic valve endocarditis

Design

Case report

Authors

LTL TulliOspedale Santa MariaGLG LattanziOspedale Santa MariaMRM RicciOspedale Santa Maria

Discussion

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Implication

Prompt surgical intervention restored conduction in this PVE case; leaves open whether it prevents permanent pacing need in larger cohorts.

Key Points

  • Describe the rapid clinical progression and management of prosthetic valve endocarditis complicated by periannular abscess and complete atrioventricular block.
  • Evaluated a 75-year-old male with a history of bioprosthetic aortic valve replacement presenting with acute heart failure symptoms and conduction delays.
  • Monitored disease course and tissue involvement using serial electrocardiograms, transesophageal echocardiography, and blood cultures.
  • Blood cultures identified Staphylococcus caprae, while serial echocardiography revealed severe intraprosthetic regurgitation and an 8 mm annular abscess at the mitro-aortic junction.
  • Conduction abnormalities progressed from PR interval prolongation (360 ms) to 2:1 atrioventricular block and complete heart block with a ventricular rate of 20 bpm.
  • Urgent redo aortic valve replacement combined with annular debridement successfully restored sinus rhythm with residual first-degree atrioventricular block.

Study Design

Type

Case Report (n=1)

Structured PICO

P
Population
A 75-year-old man with a bioprosthetic aortic valve who developed prosthetic valve endocarditis complicated by an annular abscess and complete AV block.
I
Intervention
Urgent redo aortic valve replacement with annular debridement and temporary pacing.
O
Outcome
Restoration of sinus rhythm and resolution of advanced conduction abnormalities postoperatively.

This case highlights the rapid progression of prosthetic valve endocarditis to annular abscess and complete AV block, emphasizing the need for prompt diagnosis and urgent surgical intervention.

Cite This Study

Tulli et al. (2026) conducted a case report in Prosthetic valve endocarditis (n=1). Urgent redo aortic valve replacement with annular debridement was evaluated. Urgent redo aortic valve replacement with annular debridement restored sinus rhythm in a 75-year-old man with prosthetic valve endocarditis complicated by an annular abscess and complete AV block.

synapsesocial.com/papers/6aa9017deed42882c1fc1965https://doi.org/10.1093/eurheartjsupp/suag058.170

Topics

Infective endocarditis
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Undiagnosed Subacute Bioprosthetic Aortic Valve Abscess Leading to Complete Heart Block Requiring Permanent Pacemaker Insertion: A Case Report2025
  2. 2B51-26 Resection and Reconstruction of Intraseptal Aortic Root Mycotic Pseudoaneurysm in a Patient With Suspected Prosthetic Valve Endocarditis and Complete Heart Block2026
  3. 3First-Degree Heart Block: The Guiding Light to Discovering an Aortic Root Abscess2020 · 3 citations
  4. 4Enterococcal Endocarditis in a Bicuspid Aortic Valve Associated With a Sinus of Valsalva Aneurysm2026
  5. 51-038 Aortic root abscess in prosthetic valve endocarditis: a case report2025