Infective Endocarditis Complicated With a Large Left Coronary Cusp Aneurysm: A Condition With Undefined Natural
Carlos A Roldan1, Kathleen Allen1, Michelle Ratliff1
1Division of Cardiology, Albuquerque New Mexico VA Health Care System, Albuquerque, New Mexico; Division of Cardiology, University of New Mexico School of Medicine, Albuquerque, New Mexico.
Insights
Native aortic valve infective endocarditis (NAV-IE) can cause aortic cusp aneurysms, leading to rupture and heart failure. Transcatheter aortic valve replacement (TAVR) offers a viable treatment option for high-risk patients.
Area of Science:
- Cardiology
- Infective Endocarditis
- Valvular Heart Disease
Background:
- Aortic cusp aneurysms secondary to native aortic valve infective endocarditis (NAV-IE) have poorly defined natural history and treatment strategies.
- Current valvular heart disease guidelines do not recognize this complication as an indication for surgical or transcatheter aortic valve replacement (TAVR).
Abstract:
The natural history and treatment of an aortic cusp aneurysm with or without rupture because of native aortic valve infective endocarditis (NAV-IE) have not been well defined. This may explain why current guidelines for the management of valvular heart disease do not include this complication as an indication for surgical aortic valve replacement or repair or transcatheter aortic valve replacement (TAVR). We describe herein the first case of a man aged 76 years with multiple co-morbidities with a NAV-IE associated large left coronary cusp aneurysm with subsequent rupture and consequent severe aortic regurgitation and heart failure for which he underwent an off-label successful TAVR. This patient's scenario suggests that a cusp aneurysm because of NAV-IE poses a high risk for subsequent rupture, severe aortic regurgitation, and heart failure. In conclusion, TAVR may be a reasonable alternative to high-risk surgical aortic valve replacement in patients with NAV-IE associated cusp aneurysms with or without but impending rupture.
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