ABSTRACT
A 42-year-old man presented to hospital with fever, dyspnea and fatigue. In the previous days he reported illness and cough and he had not received the vaccination for COVID-19. Moreover, he had a bicuspid aortic valve with mild insufficiency. Blood tests showed raised inflammatory markers and leukocytosis;high-sensitivity cardiac troponin T and natriuretic peptides were also elevated. Serological tests showed a recent COVID-19 infection, but the nasopharyngeal test was negative. A transesophageal echocardiogram was performed showing moderate reduction in the systolic function of the left ventricle, an aneurysm of the aortic root (52mm) and endocarditis of the aortic valve with severe insufficiency and an abscess on the mitro-aortic junction. So, he was started on empirical antibiotic therapy. For the development of multiorgan failure it was decided to replace the aortic valve, the root and the ascending aorta according to Bentall technique. The bacteriological research on blood and surgical material was negative. During rehabilitation there was a new clinical worsening with raised inflammatory markers and fever. An aortic CT angiography and a transesophageal echocardiogram were performed with evidence of a para-aortic contrast medium collection and a fistula of the prosthetic tube. The patient was then transferred to another cardiac center for a new surgery. It is important to be vigilant for the possible cardiovascular complications of COVID-19, including infective endocarditis. Early diagnosis is the corner stone for early treatment and multimodality imaging has a central role.