A cavity in the left ventricular outflow tract: a disastrous consequence of tooth decay?

摘要

A 55-YEAR-OLD, 122-kg, 178-cm man was admitted to the authors' institution for the evaluation of fever, weight loss, fatigue, and progressive dyspnea on exertion of 8 weeks' duration. The patient had undergone an uncomplicated minimally invasive aortic valve replacement with a 25-mm St Jude BioCor Epic bioprosthesis (St Jude Medical, Minneapolis, MN) for severe aortic stenosis 6 months before the current admission. Dental extractions were performed 3 months after this operation with appropriate antibiotic prophylaxis following established guidelines,1 but several dental caries extending into the tooth pulp and severe, generalized periodontal disease remained to be treated. The past medical history was also notable for poorly controlled diabetes mellitus (glycosylated hemoglobin = 10.1%), essential hypertension, hyperlipidemia, and chronic renal insufficiency (serum creatinine concentration =1.6 mg/dL).