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Infective Endocarditis Masquerade: Aortic Prosthetic Valve Degeneration and Mitral Prosthetic Valve Thrombosis

Duha Wani1, Mayra Guerrero1, Juan Crestanello2

  • 1Department of Cardiovascular Medicine, Mayo Clinic Rochester, Minnesota.

JACC. Case Reports
|June 29, 2026
PubMed

Insights

Multiple cardiac conditions, including bioprosthetic valve issues and a pseudoaneurysm, can mimic infective endocarditis. Multimodality imaging is crucial for accurate diagnosis of these complex cardiac conditions.

Area of Science:

  • Cardiology
  • Medical Imaging

Background:

  • Bioprosthetic valve failure and thrombosis are known complications.
  • Pseudoaneurysms of the intervalvular fibrosa are rare but serious cardiac conditions.
  • Differentiating these from infective endocarditis is clinically challenging.

Purpose of the Study:

  • To report a unique case presenting with a combination of aortic and mitral bioprosthetic complications and an intervalvular fibrosa pseudoaneurysm.
  • To highlight the diagnostic challenges in distinguishing these entities from infective endocarditis.
  • To emphasize the role of multimodality imaging in establishing a correct non-infectious diagnosis.

Main Methods:

  • Case report detailing clinical presentation, patient history, and diagnostic workup.
  • Comprehensive infectious workup performed.
  • Multimodality imaging utilized, including echocardiography, 4D-CT, and PET-CT.

Main Results:

  • Aortic bioprosthetic failure, mitral bioprosthetic thrombosis, and an intervalvular fibrosa pseudoaneurysm were identified.
  • Extensive infectious workup yielded negative results.
  • Multimodality imaging confirmed a non-infectious etiology for the patient's symptoms.

Conclusions:

  • A combination of cardiac bioprosthetic issues and pseudoaneurysm can present similarly to infective endocarditis.
  • Thorough patient evaluation and advanced imaging are essential for accurate diagnosis.
  • Multimodality imaging plays a critical role in identifying complex, non-infectious cardiac pathologies.
Keywords:
aortic valveechocardiographyimagingmitral valve

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