Acute aortic dissection associated with undetected congenital bicuspid aortic valve and infective endocarditis diagnosed intraoperatively.

The congenital bicuspid aortic valve (BAV) is recognized as a cause of acute aortic dissection (AAD) and also as a risk factor for infective endocarditis (IE) especially ring abscess. We experienced a case of all these combined and operated emergently. A 59-year-old man was transferred to us, and emergent operation was indicated for AAD and aortic stenosis (AS) due to BAV. However, he was strongly suspected of also having IE during the operation and the procedure was changed to a modified Bentall's method. The diagnosis was confirmed by pathological examination postoperatively. He recovered well after postoperative antimicrobial therapy without recurrent infection. It is important to remember that BAV is a risk factor for not only AAD but also IE, which sometimes occurs simultaneously and requires an emergent operation due to high mortality.