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[Prosthetic valve endocarditis after double valve replacement]

A Yamaguchi1, N Kitamura, M Kawashima

  • 1Department of Cardiovascular Surgery, Osaka National Hospital, Japan.

[Zasshi] [Journal]. Nihon Kyobu Geka Gakkai
|February 1, 1993
PubMed
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This case report highlights a fatal prosthetic valve endocarditis (PVE) complication after double valve replacement. Early diagnosis and management of PVE are critical to prevent severe outcomes like valve detachment and aortic dissection.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Surgical Pathology

Background:

  • A 54-year-old female with a history of mitral valve replacement (MVR) and aortic valve replacement (AVR) presented with symptoms suggestive of prosthetic valve endocarditis (PVE).
  • Initial diagnosis was PVE, with blood cultures positive for methicillin-resistant Staphylococcus epidermidis (MRSE).

Observation:

  • Echocardiography revealed vegetation on the mitral valve prosthesis, but intraoperative findings were inconclusive for endocarditis at the mitral or aortic positions.
  • Despite initial reoperation, persistent inflammation and a new diastolic murmur led to emergency cardiac catheterization.
  • Catheterization revealed critical complications: detachment of the aortic valve prosthesis, mycotic aneurysm with sinus of Valsalva rupture, and aortic dissection.

Findings:

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  • The patient underwent a second aortic valve re-replacement (re-AVR) and ascending aorta replacement.
  • Despite aggressive management, the patient succumbed to multiple organ failure secondary to drug-induced hepatic failure.
  • The case suggests a missed diagnosis of aortic PVE during the initial reoperation, underscoring diagnostic challenges.

Implications:

  • This case emphasizes the critical need for vigilant diagnostic evaluation of prosthetic valve endocarditis, particularly after complex cardiac surgeries.
  • It highlights the potential for rapid, catastrophic complications of PVE, including valve dehiscence and aortic root complications.
  • The report prompts re-evaluation of diagnostic modalities and surgical strategies for PVE in patients with prior valve replacements.