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Bacterial endocarditis following aortic valve replacement. Clinical and pathologic correlations
L H Cohn1, W C Roberts, D S Rockoff
1Clinic of Surgery, National Heart Institute, Diagnostic X-ray Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA.
Circulation
|April 1, 2015
Summary
Bacterial infections at prosthetic aortic valves can cause severe aortic regurgitation and fatal outcomes. Comprehensive antibiotic regimens are suggested for patients with prosthetic cardiac valves.
Area of Science:
- Cardiovascular Surgery
- Infectious Diseases
- Pathology
Background:
- Prosthetic aortic valves are used to treat aortic valve disease.
- Bacterial endocarditis is a serious complication of prosthetic valves.
Observation:
- Three patients with prosthetic aortic valves developed bacterial infections.
- Clinical presentation included acute bacterial endocarditis and severe aortic regurgitation.
Findings:
- Pathology revealed extensive necrosis of the aortic annulus, aortic wall disruption, and periaortic abscesses.
- Prosthetic valves were detached or dislodged, with one impacted in the aortic arch.
- Secondary surgery was deemed ineffective due to extensive infection.
Implications:
- Fatal staphylococcal endocarditis occurred despite penicillin prophylaxis.
- A more comprehensive antibiotic regimen is recommended for prosthetic cardiac valve patients.
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