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Acude por deterioro del estado general de 2 semanas de duración, objetivándose un bloqueo auriculoventricular completo. Ingresa en UCI, estable hemodinámicamente y con oxigenoterapia de bajo flujo. Se realiza ecocardiografía transtorácica, que evidencia una insuficiencia mitral moderada e imagen sugestiva de vegetación en el velo anterior mitral (<a class="elsevierStyleCrossRef" href="#fig0005">fig. 1</a>). Hemocultivos positivos para <span class="elsevierStyleItalic">Staphylococcus aureus</span>. La ecocardiografía transesofágica confirma una vegetación de 14<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>mm en el velo anterior mitral (A3) y evidencia un pseudoaneurisma (<a class="elsevierStyleCrossRef" href="#fig0010">fig. 2</a>,*) en la base del septo interauricular con fistulizaciones múltiples que comunican el tracto de salida del ventrículo izquierdo con ambas aurículas (<a class="elsevierStyleCrossRef" href="#fig0015">fig. 3</a>). Dada la situación basal del paciente se desestima para tratamiento quirúrgico.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Se han incluido vídeos de la ecocardiografía como <a class="elsevierStyleCrossRef" href="#sec0020">material electrónico adicional</a> que ilustran lo descrito en el texto.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financiación</span><p id="par0015" class="elsevierStylePara elsevierViewall">Este artículo no ha sido financiado.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicto de intereses</span><p id="par0025" class="elsevierStylePara elsevierViewall">Sin conflicto de intereses.</p></span></span>" 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