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Bicuspid aortic valve, aortic coarctation, and infective endocarditis in a young adult male

A 33-year-old young male patient with a history of uncontrolled hypertension was referred to my clinic due to a 2-week fever, generalized body aches, shortness of breath, and easy fatigue. Clinical examination showed a toxic dyspneic patient, but conscious and well-oriented. His blood pressure was 170/100 mm Hg, pulse 90 beat/min, respiratory rate 15/min, and the temperature was 38.6°C. Cardiac examination showed a harsh systolic murmur at the mitral area radiating to the axilla. Abdomen examination revealed moderate splenomegaly and mild hepatomegaly. The rest of the examination was unremarkable. A bedside transthoracic echocardiogram revealed mitral valve destruction with large vegetation (Fig. 1) and severe regurgitation consistent with mitral valve endocarditis (modified Duke criteria fulfilled). Furthermore, bicuspid aortic valve (BAV) was viewed (Fig. 2). Suprasternal view showed a picture consistent with aortic coarctation (CoA) (Fig. 3a and b). The patient was diagnosed with subacute endocarditis, CoA of aorta and BAV, and broad-spectrum antibiotics were started. Despite completion of antibiotics, the vegetation persisted, and he was referred to cardiac surgery unit for mitral valve replacement and surgical correction of CoA by end to end anastomosis.