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Endocarditis due to an atypical mycobacterium following porcine heart valve replacement

J A Lombardo, M F O'Rourke, M X Shanahan

    Australian and New Zealand Journal of Medicine
    |August 1, 1980
    PubMed

    Insights

    A patient developed endocarditis after aortic valve replacement with a porcine xenograph, leading to a fistula. Acid-fast bacilli, likely contaminants, were found, prompting valve replacement and fistula repair.

    Area of Science:

    • Cardiovascular Surgery
    • Infectious Diseases
    • Prosthetic Valve Complications

    Background:

    • Aortic valve replacement (AVR) using porcine xenografts is a common procedure.
    • Endocarditis is a serious complication following valve replacement surgery.
    • Fistula formation between cardiac chambers and great vessels is a rare but critical complication.

    Observation:

    • A patient developed endocarditis after AVR with a porcine xenograph.
    • The endocarditis complicated by a fistula between the aorta and the right ventricle.
    • Acid-fast bacilli were identified in the aortic wall and excised valve tissue, though no organisms were cultured.

    Findings:

    • The patient underwent successful re-operation with replacement of the xenograph with a mechanical valve.
    • The aorto-ventricular fistula was surgically closed.
    • The identified acid-fast bacilli were presumed to be contaminants from the porcine prosthesis.

    Implications:

    • This case highlights the potential for prosthetic material contamination leading to severe complications.
    • Early recognition and surgical intervention are crucial for managing complex prosthetic valve endocarditis with fistula.
    • Consideration of contaminant organisms in prosthetic valve endocarditis is important for appropriate management.

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