Perforation of a Tricuspid Pouch Caused by Infective Endocarditis

A 61-year-old man was admitted because of infective endocarditis. Echocardiography revealed the bicuspid aortic valve and a tricuspid pouch bulging into the right ventricle. Color Doppler demonstrated mild aortic regurgitation and left-to-right ventricular shunt through the lower part of the pouch. We successfully performed an aortic valve replacement and closed the interventricular communication. Infective endocarditis of the bicuspid aortic valve appeared to have caused left-to-right ventricular communication at the lower part of the tricuspid pouch.