Paravalvular Abscess of the Mechanical Prosthetic Aortic Valve: A Case Report

Main Article Content

Denis Mackic
Faruk Custovic
Edin Begic

Abstract

BACKGROUND: Prosthetic mechanical valve endocarditis (PVE) can be manifested as early PVE (acquired perioperatively) and late PVE (resulting from infections unrelated to the valve operation). Causes of both are similar but are late PVE are more prone to less virulent microbes. PVE resulting with paravalvular abscess is confirmed through echocardiography (transthoracic or transesophageal), it results with a high mortality rate especially if it is not early recognized. The aim of article was to present a patient with heart failure symptoms caused by PVE.


CASE PRESENTATION: Male patient, 44 years old, was admitted because of dyspnea and swelling of lower extremities. The patient is a long-standing heroin addict who had aortic valve replacement done 8 years ago due to endocarditis. The implanted valve was a mechanical aortic valve – Edwards MIRA bi-leaflet valve No 32 (Edwards Lifesciences; Irvine, California). He also was already diagnosed with hepatitis C years before. In multiple occasions were hospitalized on the Department of cardiology due to signs and symptoms of heart failure. On transthoracic echocardiography, dilatation of all heart chambers was found. The left ventricular systolic function was moderately reduced with an ejection fraction of left ventricle of 42% according to Simpson with restrictive filling pattern. Hypoechoic mass along the right side of the mechanical aortic valve was noted measuring 3.57 × 1.03 cm.


CONCLUSION: Paravalvular abscess of mechanical heart valves is a very serious complication with a high mortality rate. It is essential to recognize this type of pathology as early as possible, so aggressive parenteral antibiotic therapy could be started, while in many cases, surgical reoperation is needed.

Downloads

Download data is not yet available.

Article Details

How to Cite
1.
Mackic D, Custovic F, Begic E. Paravalvular Abscess of the Mechanical Prosthetic Aortic Valve: A Case Report. SEE J Cardiol [Internet]. 2022 Nov. 30 [cited 2024 Apr. 23];3(1):1-3. Available from: https://seejca.eu/index.php/seejca/article/view/6028
Section
General Cardiology

References

Tornos P. Management of prosthetic valve endocarditis: A clinical challenge. Heart. 2003;89(3):245-6. https://doi.org/10.1136/heart.89.3.245 PMid:12591815 DOI: https://doi.org/10.1136/heart.89.3.245

Ashley EA, Niebauer J. Infective endocarditis. In: Cardiology Explained. Ch. 10. London: Remedica; 2004. Available from: https://www.ncbi.nlm.nih.gov/books/NBK2208 [Last accessed on 2022 Jan 21].

Ramos Tuarez FJ, Yelamanchili VS, Law MA. Cardiac Abscess. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2020. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459132 [Last accessed on 2020 Jul 17].

Netzer RO, Altwegg SC, Zollinger E, Täuber M, Carrel T, Seiler C. Infective endocarditis: Determinants of long term outcome. Heart. 2002;88(1):61-6. https://doi.org/10.1136/heart.88.1.61 PMid:12067947 DOI: https://doi.org/10.1136/heart.88.1.61

Rekik S, Trabelsi I, Znazen A, Maaloul I, Hentati M, Frikha I, et al. Prosthetic valve endocarditis: Management strategies and prognosis: A ten-year analysis in a tertiary care Centre in Tunisia. Neth Heart J. 2009;17(2):56-60. https://doi.org/10.1007/BF03086218 PMid:19247467 DOI: https://doi.org/10.1007/BF03086218

Senining RC, Ahmad H, Shahzad R, Stahl-Avicolli A, Lamoste TJ, Soto NE, et al. Late prosthetic valve endocarditis caused by Staphylococcus hemolyticus. Clin Infect Dis. 2001;32(6):E100-1. https://doi.org/10.1086/319354 PMid:11247730 DOI: https://doi.org/10.1086/319354

Moss R, Munt B. Injection drug use and right sided endocarditis. Heart. 2003;89(5):577-81. https://doi.org/10.1136/heart.89.5.577 PMid:12695478 DOI: https://doi.org/10.1136/heart.89.5.577

Gürtler N, Osthoff M, Rueter F, Wüthrich D, Zimmerli L, Egli A, et al. Prosthetic valve endocarditis caused by Pseudomonas aeruginosa with variable antibacterial resistance profiles: A diagnostic challenge. BMC Infect Dis. 2019;19(1):530. https://doi.org/10.1186/s12879-019-4164-3 PMid:31208366 DOI: https://doi.org/10.1186/s12879-019-4164-3

Leung DY, Cranney GB, Hopkins AP, Walsh WF. Role of transoesophageal echocardiography in the diagnosis and management of aortic root abscess. Br Heart J. 1994;72(2):175-81. https://doi.org/10.1136/hrt.72.2.175 PMid:7917692 DOI: https://doi.org/10.1136/hrt.72.2.175

Westphal N, Plicht B, Naber C. Infective endocarditis- prophylaxis, diagnostic criteria, and treatment. Dtsch Arztebl Int. 2009;106(28-29):481-9. https://doi.org/10.3238/ arztebl.2009.0481 PMid:19730718

O’Gara PT. Infective endocarditis 2006: Indications for surgery. Trans Am Clin Climatol Assoc 2007;118:187-98.

Shafran SD. Infective endocarditis and perivalvular abscess: A dangerous duo. CMAJ 2002;167(1):38-9.

Ikeda A, Nakajima T, Konishi T, Matsuzaki K, Sugano A, Fumikura Y, et al. Infective endocarditis of an aorto-right atrial fistula caused by asymptomatic rupture of a sinus of Valsalva aneurysm: A case report. Surg Case Rep. 2016;3(1):43. https://doi.org/10.1186/s40792-016-0171-4 PMid:27180251 DOI: https://doi.org/10.1186/s40792-016-0171-4

Thuny F, Grisoli D, Cautela J, Riberi A, Raoult D, Habib G. Infective endocarditis: Prevention, diagnosis, and management. Can J Cardiol. 2014;30(9):1046-57. https://doi.org/10.1016/j.cjca.2014.03.042 PMid:25151287 DOI: https://doi.org/10.1016/j.cjca.2014.03.042