Bacterial endocarditis presenting as complete heart block with paradoxical (left-to-right) pulmonary emboli

Abstract The patient described presented with fever, heart block, negative blood cultures, and clinical evidence of aortic insufficiency. He was unresponsive to antibiotic therapy. Cardiac catheterization demonstrated an acquired left-to-right shunt which was probably the source of paradoxical pulmonary emboli. Surgical replacement of the infected aortic valve and closure of the demonstrated ruptured mycotic sinus of Valsalva aneurysm was curative. It is suggested that evolving intraventricular or atrioventricular conduction disturbances during the course of endocarditis indicate the presence of myocardial abscess or sinus of Valsalva aneurysm and should be taken as strong indications for prompt surgical intervention.