Key result
Emergency modified Bentall procedure controls intramyocardial hematoma bleeding, but fatal postoperative vasoplegic shock ensues.
Why the study?
Periannular extension of native aortic valve infective endocarditis can lead to abscess formation, pseudoaneurysms, and fistulae, and this report describes an unusual complication involving a right ventricular intramyocardial dissecting hematoma from a contained rupture of a right sinus of Valsalva pseudoaneurysm.
Case Report (n=1)
No
This case report highlights a rare and fatal complication of destructive native aortic valve infective endocarditis in which a right sinus of Valsalva pseudoaneurysm ruptured into the right ventricular free wall, causing an intramyocardial dissecting hematoma and subsequent cardiac tamponade.
Answers are grounded in this paper and cite their sources.
Surgery resolved hematoma bleeding but fatal vasoplegia followed; case report extends known periannular complications of aortic valve endocarditis while leaving management open.
Periannular extension of native aortic valve infective endocarditis may lead to abscess formation, pseudoaneurysms, and fistulous communications with adjacent cardiac structures.We report an unusual complication involving a right ventricular intramyocardial dissecting hematoma caused by contained rupture of an infective pseudoaneurysm of the right sinus of Valsalva.A 29-year-old woman presented with severe chest pain radiating to the back, rapidly progressive dyspnea, and hemodynamic shock following one month of intermittent fever.Computed tomography angiography revealed massive hemopericardium and a suspected ruptured pseudoaneurysm of the right sinus of Valsalva.Emergency surgery initially revealed active bleeding from a right ventricular intramyocardial dissecting hematoma following evacuation of the massive hemopericardium.A subsequent aortic exploration showed destructive infective endocarditis of the native aortic valve, complicated by a pseudoaneurysm of the right sinus of Valsalva that had ruptured in a contained way into the free wall of the right ventricle.Radical debridement, a modified Bentall replacement, and coronary revascularization using a Y-shaped saphenous vein graft were performed.Despite emergency surgery, the patient died from refractory postoperative vasoplegic shock.This case demonstrates an unusual pathway of rupture of a right sinus of Valsalva pseudoaneurysm in destructive native aortic valve infective endocarditis, in which intramyocardial dissection of the right ventricular free wall preceded hemopericardium and cardiac tamponade.
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Abetti et al. (2026) conducted a case report in Native aortic valve infective endocarditis complicated by ruptured right sinus of Valsalva pseudoaneurysm and right ventricular intramyocardial dissecting hematoma (n=1). Modified Bentall procedure and saphenous vein Y-graft coronary artery bypass was evaluated on Postoperative survival. Emergency modified Bentall procedure with Y-graft coronary revascularization resolved active intramyocardial hematoma bleeding, but the patient died on postoperative day 2 from vasoplegic shock.
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