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A Case of Fungal Prosthetic Valve Endocarditis Complicated by Embolic ST-Elevated Myocardial Infarction

Yudai Tanaka1, Yuki Saito1, Riku Arai1

  • 1Division of Cardiology, Department of Medicine, Nihon University School of Medicine.

International Heart Journal
|February 2, 2025
PubMed

Insights

Fungal prosthetic valve endocarditis (PVE) can cause ST-elevation myocardial infarction (STEMI), a rare complication of infective endocarditis. Real-time 3D-transesophageal echocardiography aided diagnosis and assessment, leading to favorable outcomes.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Echocardiography

Background:

  • Acute coronary syndrome (ACS) is a rare but high-mortality complication of infective endocarditis (IE).
  • Coronary artery occlusion typically arises from bacterial IE in native valves.
  • Prosthetic valve endocarditis (PVE) is less commonly associated with ACS.

Purpose of the Study:

  • To report a case of ST-elevation myocardial infarction (STEMI) caused by fungal PVE.
  • To highlight the utility of real-time 3D-transesophageal echocardiography (3D-TEE) in diagnosing fungal PVE presenting as STEMI.

Main Methods:

  • Case presentation of a 74-year-old woman with a history of aortic valve replacement and rheumatoid arthritis on immunosuppressants.
  • Diagnosis of STEMI via coronary angiography (CAG) showing left circumflex artery occlusion.
  • Identification of Candida albicans vegetation via 3D-TEE and histopathology, confirming fungal PVE.

Main Results:

  • The patient presented with STEMI, later diagnosed with Candida albicans PVE.
  • 3D-TEE was crucial for detecting and assessing vegetation.
  • Surgical prosthetic valve replacement and antifungal treatment led to a favorable outcome.

Conclusions:

  • Fungal PVE can manifest as STEMI, challenging typical presentations.
  • Real-time 3D-TEE is a valuable tool for diagnosing fungal PVE in STEMI patients.
  • Prompt diagnosis and management of fungal PVE are critical for improving patient outcomes.
Keywords:
EchocardiographyInfectious endocarditisIschemic heart disease

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