A case of transcatheter prosthetic aortic valve endocarditis

Abstract

Transcatheter aortic valve implantation (TAVR) constitutes an established treatment in inoperable or high perioperative risk patients with severe aortic stenosis. Prosthetic valve endocarditis after ΤΑVR occurs with an incidence of 0.3-1% per patient-year. Infective endocarditis may stem from hematogenous dissemination or contact with infected adherent tissue. Few cases of infective endocarditis after TAVR have been reported. We present an interesting case of a 79-year-old male with a history of severe aortic stenosis status post TAVR greater than one year ago, and pulmonary vein isolation for atrial fibrillation six weeks ago was found to have infective endocarditis with a vegetation on the prosthetic valve leading to multiple embolic strokes as a result of Enterococcus faecalis bacteremia. The patient was not a surgical candidate with his Society of Thoracic Surgery (STS) risk score being 18%; therefore, he was managed conservatively on intravenous antibiotics. Our case had endocarditis from enterococcus bacteremia; however, the patient never had any gastrointestinal or genitourinary procedure.

Recurrent Multivalvular Staphylococcus Lugdunensis Endocarditis Causing Complete Heart Block after TAVR

“…TAVR is associated with a unique set of complications [1,2]. Albeit uncommon (incidence: 1-3%), PVE following TAVR is associated with an in-hospital mortality rate of 36% and a 2-year mortality of 67% according to a large 250 case registry [1,3]. The risk of PVE is highest in the first year after TAVR; the most common organisms implicated overall are Streptococcus spp.…”

Role of Multimodality Imaging in Transcatheter Structural Interventions

“…For TAVI, it ranges from 0.4% to 2.8% depending on the time of implantation: for instance, early (< 3 months post-procedure) carries the highest incidence, while late (> 1 year after) is the lowest. 5 Utilizing TEE for preprocedural evaluation is key in determining the feasibility of MV edge-to-edge repair (TEER). Evaluation of MV TEER involves the following: (1) posterior leaflet length should be ≥ 7 mm; (2) diastolic MV area measured on a 2D multiplanar reconstruction (MPR) of the 3D MV acquisition should be ≥ 4 cm 2 ; (3) assessing location of flail/prolapsed segment (medial segments, A3/P3, are less favorable); (4) assessing fossa ovalis height (favorable to have at least 4 cm from the fossa to the plane of the MV, especially in Barlow's MV); and (5) evaluating baseline transvalvular mean gradient (MG).…”