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[Aortic and mitral valve endocarditis after infection of the pacemaker pocket]
Abstract:
The case of a 76-year-old diabetic patient with known aortic valve sclerosis is reported. One week after implantation of a permanent pacemaker system (indication: 2nd degree AV-block type Mobitz) he developed fever. Large endocarditic vegetations were found on the aortic and mitral valve (blood cultures: were positive for Staphylococcus aureus). Also from the pacemaker bed Staphylococcus aureus was isolated and an antibiotic treatment including vancomycin was started. Nevertheless the patient developed insufficiencies of both the aortic and mitral valves and became hemodynamically unstable. Due to cerebral embolisms and further deterioration of the patient's overall clinical state the already planned operative replacement of the aortic and mitral valve could not be performed. The patient died because of left ventricular failure after pacemaker infection which was complicated by endocarditis.
Insights
Pacemaker infection with Staphylococcus aureus led to severe endocarditis in a diabetic patient. This complication caused valve damage and hemodynamic instability, ultimately resulting in death.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Devices
Background:
- A 76-year-old diabetic patient with aortic valve sclerosis received a permanent pacemaker for Mobitz type II atrioventricular block.
- Pacemaker implantation is a common procedure for bradyarrhythmias.
Observation:
- One week post-pacemaker implantation, the patient developed fever.
- Blood cultures and pacemaker pocket cultures identified Staphylococcus aureus.
- Large vegetations were observed on the aortic and mitral valves, indicative of infective endocarditis.
Findings:
- Despite antibiotic treatment with vancomycin, the patient experienced worsening aortic and mitral valve insufficiency.
- The patient became hemodynamically unstable with evidence of cerebral embolisms.
- The planned aortic and mitral valve replacement surgery could not be performed due to clinical deterioration.
Implications:
- Pacemaker pocket infections can lead to severe infective endocarditis, particularly with Staphylococcus aureus.
- Early diagnosis and aggressive management are crucial for patients with pacemaker-related endocarditis.
- This case highlights the potential for serious complications following pacemaker implantation, even with appropriate antibiotic therapy.