A Large Aortic Root Mycotic Aneurysm with Complete Heart Block: A Rare Complication of Infective Endocarditis

Infective endocarditis of aortic valve with peri-annular extension leading to a large mycotic aneurysm of aortic root is a rare yet grave complication. A 65-year-old male presented with on and off fever since 2 years, and dyspnea since 20 days. ECG showed complete heart block with narrow complex escape rhythm. Echocardiography study showed Rheumatic Heart Disease with severe mitral regurgitation and mild aortic regurgitation. There was a 53 * 47 mm thick walled mycotic aneurysm of aortic root posterior coronary sinus. Duke’s criteria were suggestive of definite infective endocarditis, though the blood culture was negative. To the best of our knowledge, this is the largest aortic root mycotic aneurysm reported till date.