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Case Reports
. 2015 Apr 1;42(2):172-4.
doi: 10.14503/THIJ-13-3961. eCollection 2015 Apr.

Prosthetic valve endocarditis with valvular obstruction after transcatheter aortic valve replacement

Christine Pabilona, Bernard Gitler, Jeffrey A Lederman, Donald Miller, Theodore N Keltz
Case Reports

Prosthetic valve endocarditis with valvular obstruction after transcatheter aortic valve replacement

Christine Pabilona et al. Tex Heart Inst J. .

Abstract

Patients with severe aortic stenosis who are at high risk for open-heart surgery might be candidates for transcatheter aortic valve replacement (TAVR). To our knowledge, this is the first report of Streptococcus viridans endocarditis that caused prosthetic valve obstruction after TAVR. A 77-year-old man who had undergone TAVR 17 months earlier was admitted because of evidence of prosthetic valve endocarditis. A transthoracic echocardiogram revealed a substantial increase in the transvalvular peak gradient and mean gradient in comparison with an echocardiogram of 7 months earlier. A transesophageal echocardiogram showed a 1.5-cm vegetation obstructing the valve. Blood cultures yielded penicillin-sensitive S. viridans. The patient was hemodynamically stable and was initially treated with vancomycin because of his previous penicillin allergy. Subsequent therapy with levofloxacin, oral penicillin (after a negative penicillin skin test), and intravenous penicillin eliminated the symptoms of the infection. Transcatheter aortic valve replacement is a relatively new procedure, and sequelae are still being discovered. We recommend that physicians consider obstructive endocarditis as one of these.

Keywords: Anti-bacterial agents/therapeutic use; aortic valve stenosis/complications/therapy; aortic valve/surgery; endocarditis, bacterial/diagnosis/therapy; heart valve prosthesis implantation/adverse effects/methods; postoperative complications; prosthesis-related infections/drug therapy; treatment outcome.

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Figures

Fig. 1
Fig. 1
Transesophageal echocardiogram (midesophageal view at 125°) shows the vegetation (arrow) and the bioprosthetic valve (arrowhead). Ao = aorta; LA = left atrium; LV = left ventricle; RV = right ventricle
See this image and copyright information in PMC

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