An unusual case report of transcatheter aortic valve implantation-related actinomycosis endocarditis

Abstract

Background: Actinomycosis is a chronic invasive infection caused by Actinomyces species. Actinomycosis endocarditis has been described, yet considered rare. We present the first reported transcatheter aortic valve implantation (TAVI)-related actinomycosis endocarditis.

Case summary: A 70-year-old female patient, presented 4 months after TAVI with malaise and vocal-cord paralysis. She underwent computed tomography angiography which demonstrated a 28 mm pseudoaneurysm of the ascending aorta, which compressed the laryngeal nerves. Her condition rapidly deteriorated with cardiogenic shock and required an emergent surgery, which reviled a tamponade with active bleeding, due to an ascending aortic dissection. She underwent aortic valve and ascending aorta replacement. A 2 cm vegetation was found on the TAVI prosthetic valve and sent for cultures, which later revealed an Actinomyces neuii infection. Long-term intravenous ampicillin treatment was given.

Discussion: This case describes a patient with endocarditis on TAVI prosthetic valve, with an unusual clinical presentation and rapid deterioration to an emergency intervention. This unique presentation of tumour-like tissue invasion is characteristic of actinomycosis, and should be suspected especially following valve replacement.

Keywords: Actinomycosis; Case reports; Endocarditis; Transcatheter aortic valve implantation.

Figure 1

Computed tomography angiography sagittal view (A) and axial view (B) of pseudoaneurysm from the ascending aorta (arrows), in a patient after transcatheter aortic valve implantation. Note the large pericardial effusion.

Figure 2

Transthoracic echocardiography showing the aortic valve and proximal ascending aorta, note the pseudoaneurysm flap (white arrow). AV, aortic valve.

Figure 3

Transoesophageal echocardiography in systole (A) and diastole (B), long axis view. Arrows pointing to the markedly thickened aortomitral continuity, suggesting an abscess formation. MV, mitral valve; AV, aortic valve; LA, left atrium; LV, left ventricle.

Figure 4

The prosthetic valve (Symetis SA valve; Boston Scientific Company, Ecublens, Switzerland) covered with a vegetation upon its ventricular surface. (A) Aortic view. (B) Left ventricle view.