Prosthetic valve endocarditis after double valve replacement with the Manouguian procedure

Prosthetic valve endocarditis is a rare but severe complication after double mitral and aortic valve replacement. It is debated whether or not all prostheses should be replaced simultaneously, because of high operative mortality with redo double valve replacement. We report a case of prosthetic valve endocarditis after double mitral and aortic valve replacement with the Manouguian procedure. A 56-year-old man had undergone double valve replacement 12 years prior and presented with high fever 2 months after dental treatment. Enterococcus faecalis was isolated from blood cultures twice. Transthoracic echocardiography showed perivalvular mitral regurgitation, but no vegetations or abscess. Transesophageal echocardiography revealed an abscess on the aortomitral continuity of the Manouguian patch. We removed all previous prostheses and performed redo aortic and mitral valve replacements with a repeat Manouguian procedure. The postoperative course was satisfactory. Precise preoperative evaluation by transesophageal echocardiography and radical removal of the infected prostheses resulted in successful treatment.