Stent-Related Infective Endocarditis Revealing Aortic Cusp Perforation on Intraoperative TEE: A Case Report Altering...

Coronary stent infective endocarditis (IE) is a rare but serious complication of percutaneous coronary intervention. Extension to adjacent valvular structures, particularly causing cusp perforation of the aortic valve, is exceedingly uncommon. Intraoperative transesophageal echocardiography (TEE) may reveal complications not detected preoperatively, thereby changing surgical plans. We report a patient who underwent coronary angioplasty followed by persistent fever and suspicion of stent infection. Angiography detected stent related left anterior descending artery aneurysm and preoperative plan for stent explantation and revascularization was made. However, on the operating table, intraoperative TEE demonstrated perforation of the right coronary cusp of the aortic valve with severe aortic regurgitation. Surgical strategy was modified to include stent explantation, coronary artery bypass graft (CABG), and aortic valve replacement. The stent specimen showed evidence of infection. The patient's postoperative course was favorable under targeted antibiotic therapy. This case illustrates how intraoperative TEE can uncover unanticipated valvular destruction in stent-related IE and meaningfully alter surgical decision-making. Early recognition, imaging vigilance, and flexibility in surgical planning are essential in management of such rare but high-risk complications.