Recurrent staphylococcus epidermidis prosthetic valve endocarditis with deep sternal infection in repaired tetralogy...

Advances in surgical and medical management have significantly improved survival rates for patients with congenital heart disease (CHD), especially tetralogy of Fallot (TOF), which is the most common cyanotic CHD, with a 20-year survival rate of more than 90 %.However, this growing adult TOF population faces emerging challenges, particularly a 35-fold increased risk of infective endocarditis (IE) compared to the general population.

We describe a 26-year-old male with repaired tetralogy of Fallot (TOF) who experienced recurrent prosthetic valve endocarditis (PVE) caused by Staphylococcus epidermidis over three years. The patient required three pulmonary valve replacements (PVRs) secondary to bioprosthetic valve dysfunction. Although initial endocarditis episodes were successfully treated with antibiotic therapy, the final presentation was complicated by a deep sternal wound infection, presumably seeded from multiple prior sternotomies.

Prosthetic valve endocarditis, deep sternal wound infection, perivalvular abscess formation, prosthetic valve dislocation, and aorto-pulmonary fistula development; their simultaneous occurrence underscores a critical pathophysiological triad: (1) cumulative prosthetic material burden, (2) compromised thoracic defense mechanisms from multiple sternotomies, and (3) healthcare access disparities exacerbating delayed detection.

This case underscores the persistent risk of PVE in TOF patients requiring repeated valve interventions and the critical relationship between sternal wound complications and hematogenous seeding of prosthetic valves. The clinical challenges of managing recurrent endocarditis in the setting of complex congenital heart disease are discussed.