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Coronary artery embolism and culture-negative endocarditis post Bentall's procedure

Jared McNeill1, Hong Chew1, David Andresen2

  • 1Department of Cardiothoracic Surgery, St Vincent's Hospital, Sydney, NSW, Australia.

Journal of Surgical Case Reports
|October 11, 2021
PubMed

Insights

Afebrile infective endocarditis, especially in prosthetic heart valve patients, poses diagnostic challenges. This case highlights coronary artery embolism as an unusual complication, emphasizing early consideration of endocarditis even without typical symptoms.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Internal Medicine

Background:

  • Infective endocarditis (IE) is a significant cause of illness and death.
  • Classic IE presentation includes fever and nonspecific symptoms, but diagnosis is difficult in afebrile patients with negative blood cultures.
  • Prosthetic heart valves increase IE risk.

Observation:

  • This case highlights IE in a patient without typical fever or elevated inflammatory markers.
  • The patient had a prosthetic heart valve, a known risk factor for IE.
  • Diagnosis was delayed due to the absence of classic symptoms.

Findings:

  • The study discusses an unusual IE complication: coronary artery embolism.
  • This embolism led to myocardial infarction (heart attack).
  • It underscores the need for vigilance in diagnosing IE, even with atypical presentations.

Implications:

  • Clinicians must consider IE in patients with prosthetic valves, even without fever or elevated inflammatory markers.
  • Prompt diagnosis and treatment are crucial to avoid severe complications like myocardial infarction.
  • This case emphasizes the diverse clinical manifestations of infective endocarditis.

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