Successful Treatment of Infective Endocarditis at 33 Weeks' Gestation Causing Acute Left Heart Failure

Abstract

Although infective endocarditis (IE) during pregnancy is rare, it is associated with high maternal and fetal mortality rates. Educating pregnant women on infection prevention is essential. If IE occurs, multidisciplinary collaboration is important to determine an optimal strategy for childbirth and surgery in its successful management.

Keywords: acute left heart failure; cesarean section; infective endocarditis; mitral regurgitation; pregnancy.

FIGURE 1

Electrocardiogram and transthoracic echocardiography on admission. (a) Electrocardiogram: Sinus tachycardia with a heart rate of 118 bpm was observed. (b) Preoperative transthoracic echocardiography: LVDd; 49 mm, LVDs; 31 mm, LAD; 45 mm, AoD; 24 mm, LVPWth; 8.3 mm, IVST; 7.7 mm, LVEF; 65%, MR severe, AR(−), TR mild, PR mild, sPAP; 30 mmHg, mPAP; 15 mmHg, Wall motion; Normokinesis, Echo free space; 7 mm on the left ventricular side. A 20 mm abnormal structure was attached to the mitral valve, with associated severe mitral valve regurgitation. (c) Postoperative transthoracic echocardiography: LVDd; 43 mm, LVDs; 31 mm, LAD; 29 mm, AoD; 23 mm, LVPWth; 8.4 mm, IVST; 6.8 mm, LVEF; 56%, MR mild, AR(−), TR mild, PR(−), sPAP; 27 mmHg, mPAP; 12 mmHg, Wall motion; Normokinesis, Echo free space(−). St. Jude Medical; A 25 mm mechanical valve was placed, leading to improved mitral regurgitation. *AoD, aortic dimension; AR, aortic regurgitation; IVST, interventricular septum thickness; LAD, left atrial dimension; LVDd, left ventricular end‐diasstolic diameter; LVDs, left ventricular end‐systolic diameter; LVEF, left ventricular ejection fraction; LVPWth, left ventricular posterior wall thickness; mPAP, mean pulmonary artery pressure; MR, mitral regurgitation; PR, pulmonary regurgitation; sPAP, systolic pulmonary artery pressure; TR, tricuspid regurgitation.

FIGURE 2

Progress from Day 1 to Day 5 of hospitalization. On the second day of hospitalization, infective endocarditis (IE) was suspected, so antibiotics were changed from cefozopran (CZOP) 1 g/12 h to sulbactam/ampicillin (SBT/AMPC) 3 g/6 h. An emergency cesarean section (ECS) was performed on the same day, and intensive care included cyclic management with dopamine, dobutamine, midazolam, fentanyl, and furosemide. Intra‐aortic balloon pumping (IABP) was also inserted postoperatively. Heparin was continuously administered with a target of activated clotting time (ACT) of 200 s due to the IABP. With these treatments, there was no increase in lochia or wound bleeding, and D‐dimer levels gradually decreased. By Day 5 of hospitalization, although some pulmonary congestion persisted, the cardiac shadow had reduced, and left heart failure was improving.