Ieva Petkutė1, Gerda Mierkytė1, Vaida Mizarienė2
1Lithuanian University of Health Sciences, Medical Academy, Faculty of Medicine, Kaunas, Lithuania
2Department of Cardiology, Hospital of Lithuanian University of Health Sciences, Kaunas clinics, Kaunas, Lithuania
Abstract
Background. Infective endocarditis (IE) is a severe, complex disease more common in individuals with prosthetic heart valves, previous IE, or certain congenital heart diseases. It poses significant diagnostic and treatment challenges, often leading to serious complications and a high mortality rate.
Case representation. Three years post-complex surgery 6 years ago, the patient experienced unexplained syncope, revealing > 90 % stenosis of the right internal carotid artery. Febrile temperature during neurosurgical planning led to antibacterial treatment for E. faecalis bacteremia. Echocardiography (TEE) revealed aortic valve (AV) prosthesis vegetation, resulting in a complication-free redo AV surgery and carotid endarterectomy. Three months ago, planned hip joint surgery but increased inflammatory markers and S. sanguinis bacteremia led to diagnosing AV IE with huge vegetation. IE was complicated by left iliac artery acute embolic occlusion and right iliac artery chronic subocclusion, both addressed surgically. TEE indicated vegetation reduction (1.5-1.3 cm). Post-antibiotic treatment, a resternotomy with third AV replacement was performed. Despite the challenging journey, the patient reports feeling well.
Conclusion. Infective endocarditis is a rare but serious complication following aortic valve replacement, posing a high risk of morbidity and mortality. Early detection, vigilant monitoring, and prompt treatment are crucial to minimize adverse outcomes and improve patient quality of life. Doctors must be particularly attentive to patients post-surgery to manage this life-threatening condition effectively.
Keywords: infective endocarditis, aortic valve, aortic valve replacement, antibiotic therapy.