Singhal Preeti, Kanjanauthai Somsupha, Kwan Wilson
Department of Internal Medicine, Keck School of Medicine of USC, Los Angeles, CA, USA.
Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, USA.
Case Rep Cardiol. 2021 Nov 1;2021:5334088. doi: 10.1155/2021/5334088. eCollection 2021.
Prosthetic valve endocarditis after transcatheter aortic valve replacement (PVE after TAVR) is a feared complication most often observed during the early postprocedural period. We report a case of severe, multivalvular PVE after TAVR with complete heart block caused by an uncommon organism. A 78-year-old female with prior mitral valve endocarditis treated with antibiotics presented one year later with severe, symptomatic aortic insufficiency. She subsequently underwent TAVR given high surgical risk. Six weeks post-TAVR, she presented with syncope, fever, and complete heart block. Transthoracic echocardiogram was not demonstrative of vegetation. Blood cultures were positive for s. Transesophageal echocardiogram (TEE) demonstrated vegetations of the aortic, mitral, and tricuspid valves and aorto-mitral continuity. While awaiting surgery, the patient developed cardiac arrest; she was resuscitated and taken to surgery emergently. The patient underwent TAVR explantation, bovine pericardial tissue aortic and porcine bioprosthetic mitral valve replacements, and tricuspid valve repair. Additionally, left main coronary artery endarterectomy was performed due to presence of infectious vegetative material. is an unusual but virulent organism that may damage both native and prosthetic valves. Early surgery is recommended for PVE after TAVR, especially in cases with perivalvular disease causing conduction abnormalities. TAVR has revolutionized the management of severe aortic stenosis and has even been successfully utilized in select cases of aortic regurgitation. Unfortunately, there are a number of associated complications that can be difficult to diagnose, such as prosthetic valve endocarditis (PVE). We emphasize maintaining a high clinical suspicion for PVE after TAVR in patients presenting with conduction abnormalities and highlight the importance of early surgical management in cases complicated by heart block, abscesses, or destructive penetrating lesions.
经导管主动脉瓣置换术后人工瓣膜心内膜炎（TAVR术后PVE）是一种令人担忧的并发症，最常在术后早期出现。我们报告一例TAVR术后严重的多瓣膜PVE病例，由一种罕见病原体引起并伴有完全性心脏传导阻滞。一名78岁女性曾因二尖瓣心内膜炎接受抗生素治疗，一年后出现严重的有症状的主动脉瓣关闭不全。由于手术风险高，她随后接受了TAVR。TAVR术后六周，她出现晕厥、发热和完全性心脏传导阻滞。经胸超声心动图未显示有赘生物。血培养结果显示s呈阳性。经食管超声心动图（TEE）显示主动脉瓣、二尖瓣和三尖瓣有赘生物以及主动脉 - 二尖瓣连续性中断。在等待手术期间，患者发生心脏骤停；经复苏后紧急送往手术室。患者接受了TAVR瓣膜取出术、牛心包组织主动脉瓣和猪生物瓣二尖瓣置换术以及三尖瓣修复术。此外，由于存在感染性赘生物，还进行了左主冠状动脉内膜切除术。 是一种不常见但毒性很强的病原体，可损害天然瓣膜和人工瓣膜。对于TAVR术后的PVE，建议早期手术，尤其是在伴有导致传导异常的瓣周疾病的情况下。TAVR彻底改变了严重主动脉瓣狭窄的治疗方式，甚至已成功应用于某些主动脉瓣反流病例。不幸的是，有许多相关并发症可能难以诊断，如人工瓣膜心内膜炎（PVE）。我们强调对于出现传导异常的TAVR术后患者要高度怀疑PVE，并强调在并发心脏传导阻滞、脓肿或破坏性穿透性病变的病例中早期手术治疗的重要性。
