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Heart transplantation for intractable prosthetic valve endocarditis
V J DiSesa1, L J Sloss, L H Cohn
1Department of Surgery, Brigham and Women's Hospital, Boston, MA 02115.
The Journal of Heart Transplantation
|March 1, 1990
Summary
Systemic lupus erythematosus patients with infective endocarditis face complex cardiac issues. Aggressive treatment, including valve replacement and transplantation, is crucial for managing recurrent infections and heart failure.
Area of Science:
- Cardiology
- Infectious Diseases
- Rheumatology
Background:
- Systemic lupus erythematosus (SLE) can lead to infective endocarditis and valvular heart disease.
- Previous aortic valve replacement for lupus endocarditis complicated by prosthetic valve dysfunction and infection.
Observation:
- A 25-year-old woman presented with severe aortic and mitral regurgitation 9 years post-aortic valve replacement.
- Initial management involved double-valve replacement with mechanical prostheses, complicated by persistent fever and leukocytosis.
Findings:
- Recurrent perivalvular regurgitation and heart block were observed, leading to reoperation.
- Mycoplasma hominis infection was identified, necessitating long-term antibiotic therapy.
- Despite treatment, recurrent regurgitation and congestive heart failure led to orthotopic heart transplantation.
Implications:
- This case highlights the challenges in managing complex cardiac infections in SLE patients.
- Aggressive surgical and medical interventions, including heart transplantation, may be required.
- Early recognition and management of prosthetic valve dysfunction and infection are critical.