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Stent-Related Infective Endocarditis Revealing Aortic Cusp Perforation on Intraoperative TEE: A Case Report Altering
Rajesh Madavathazathil Gopalakrishnan1, Dheeraj Arora1, Akhil Diwan2
1Department of Cardiac Anesthesia, Amrita Institute of Medical Sciences, Faridabad, Haryana, India.
Annals of Cardiac Anaesthesia
|July 13, 2026
Summary
Coronary stent infective endocarditis (IE) is rare but serious. Intraoperative transesophageal echocardiography (TEE) identified unexpected aortic valve perforation, altering surgical plans for a patient with persistent fever after stenting.
Area of Science:
- Cardiology
- Infectious Diseases
- Surgical Innovation
Background:
- Coronary stent infective endocarditis (IE) is a rare complication following percutaneous coronary intervention.
- Extension of infection to adjacent valvular structures, such as aortic valve cusp perforation, is exceptionally uncommon.
Purpose of the Study:
- To highlight the critical role of intraoperative transesophageal echocardiography (TEE) in diagnosing unexpected valvular complications in stent-related IE.
- To emphasize the impact of intraoperative imaging on modifying surgical strategies for complex IE cases.
Main Methods:
- Case report of a patient with persistent fever and suspected coronary stent infection post-angioplasty.
- Preoperative angiography revealed a stent-related aneurysm.
- Intraoperative TEE identified right coronary cusp perforation and severe aortic regurgitation, leading to a revised surgical plan.
Main Results:
- Intraoperative TEE revealed previously undetected aortic valve perforation, a complication not seen preoperatively.
- Surgical strategy was modified from stent explantation and revascularization to include aortic valve replacement.
- The explanted stent specimen confirmed infection, and the patient had a favorable postoperative outcome with targeted antibiotics.
Conclusions:
- Intraoperative TEE is invaluable for detecting unanticipated valvular destruction in stent-related IE, significantly influencing surgical decisions.
- Early recognition, vigilant imaging, and adaptable surgical planning are crucial for managing these rare but high-risk complications.
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