Event Title

Recurrent bacterial endocarditis after Prosthethetic valve replacement for native valve endocarditis complicated by perivalvular abscess: A case report

Location

Auditorium Pond Side

Start Date

26-2-2014 10:30 AM

Abstract

Introduction:Infective endocarditis involving left side of heart remains a major medical problem with numerous complications and considerable morbidity and mortality despite advancements in surgical and medical management ; Presence of prosthetic valve is one of the major factors associated with shortened overall survival in patients with IE and increases the risk of recurrence of endocarditis after valve replacement for native valve endocarditis( NVE); with recurrence rates varying from 10-15%. This is a unique case report that highlights recurrent infective endocarditis after prosthetic valve replacement for NVE ; with initial native valve disease complicated by perivalvular abscess and heart failure and later on prosthetic valve endocarditis(PVE) complicated by stroke and perivalvular leakage and regurgitant murmur leading to redo MVR.

Case Report: 56 year old gentleman presented to the medicine department of AKUH with a 15-20 days history of high grade fever, GI discomfort and dysuria. Examination revealed a PSM radiating to axilla and Blood culture showed MRSA. Transthorasic and Trans esophageal echo revealed vegetations on both leaflets of mitral valve with a perivalvular abscess. Antibiotics were started, but since the course was complicated by CHF, early MVR was done with bio prosthetic valve. 2 years later, the patient landed with PVE complicated by Right MCA infarct, coagulase negative Staphylococcus (not aureus) on blood culture and vegetation with increased gradients on TEE. Patient was treated medically with antibiotics and anticoagulants and discharged only with follow up echocardiograms; only to be readmitted 3 months later for redo MVR as the patient developed perivalvular leakage and severe MR.

Conclusion: Recurrent infective endocarditis after prosthetic valve replacement for NVE adds to increased morbidity and mortality already associated with left sided endocarditis. The cause is multifactorial; duration of antibiotic therapy, complications and timing of surgery and surgical procedure performed, all play an important etiological role. Perivalvular abscess is a feared complication of left sided endocarditis and should be treated with antibiotics and surgically.

Keywords: infective endocarditis, PVE: prosthetic valve endocarditis, NVE: native valve endocarditis, perivalvular abscess

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Feb 26th, 10:30 AM

Recurrent bacterial endocarditis after Prosthethetic valve replacement for native valve endocarditis complicated by perivalvular abscess: A case report

Auditorium Pond Side

Introduction:Infective endocarditis involving left side of heart remains a major medical problem with numerous complications and considerable morbidity and mortality despite advancements in surgical and medical management ; Presence of prosthetic valve is one of the major factors associated with shortened overall survival in patients with IE and increases the risk of recurrence of endocarditis after valve replacement for native valve endocarditis( NVE); with recurrence rates varying from 10-15%. This is a unique case report that highlights recurrent infective endocarditis after prosthetic valve replacement for NVE ; with initial native valve disease complicated by perivalvular abscess and heart failure and later on prosthetic valve endocarditis(PVE) complicated by stroke and perivalvular leakage and regurgitant murmur leading to redo MVR.

Case Report: 56 year old gentleman presented to the medicine department of AKUH with a 15-20 days history of high grade fever, GI discomfort and dysuria. Examination revealed a PSM radiating to axilla and Blood culture showed MRSA. Transthorasic and Trans esophageal echo revealed vegetations on both leaflets of mitral valve with a perivalvular abscess. Antibiotics were started, but since the course was complicated by CHF, early MVR was done with bio prosthetic valve. 2 years later, the patient landed with PVE complicated by Right MCA infarct, coagulase negative Staphylococcus (not aureus) on blood culture and vegetation with increased gradients on TEE. Patient was treated medically with antibiotics and anticoagulants and discharged only with follow up echocardiograms; only to be readmitted 3 months later for redo MVR as the patient developed perivalvular leakage and severe MR.

Conclusion: Recurrent infective endocarditis after prosthetic valve replacement for NVE adds to increased morbidity and mortality already associated with left sided endocarditis. The cause is multifactorial; duration of antibiotic therapy, complications and timing of surgery and surgical procedure performed, all play an important etiological role. Perivalvular abscess is a feared complication of left sided endocarditis and should be treated with antibiotics and surgically.

Keywords: infective endocarditis, PVE: prosthetic valve endocarditis, NVE: native valve endocarditis, perivalvular abscess