Introduction: Infective Endocarditis (IE) following TAVI procedure is a rare complication. Operability
of these patients has to be considered carefully. Detection of endocarditis is difficult.
Residual incompetence of the TAVI is often noticed and echocardiographic diagnostic
procedures may be complex. We report on a patient who underwent a TAVI procedure in
2013 and developed endocarditis which was followed by an open replacement with the
Intuity valve.
Case Report: A 83-year-old men, with a history of an TAVI replacement “Direct Flow Medical, 25mm”
in 2013 and a balloon valvuloplasty, due to a re-stenosis 2015 presented with progredient
exertional dyspnea. Physical examination showed cardiac decompensation and a midsystolic
murmur. Medical history revealed therapy resistant atrial fibrillation, left brain
stroke in 2013, COPD Gold I-II, sleep apnea (CPAP therapy), cardiac vascular risk
factors: hypertension, obesity (BMI 29.4 kg/m2) as well as main steam and 1 vessel coronary heart disease (HS/RIVA/D1-PTCA). Blood
tests revealed increased leucocytes and CRP. A transesophageal ultrasound was performed
and showed a progressive gradient over the replaced aortic valve (Vmax: 3.9 m/s, MaxPG:
60 mm Hg, mean PG: 32 mm Hg) a stenosis of the artificial valve was diagnosed as well
as a thickened leaflet tissue and restricted separation of the valve leaflets. Based
on the medical history and the information of positive blood cultures (Enterococcus faecalis), the heart team indicated an open aortic valve replacement. EuroSCORE raised from
19% (2013) to 32% (2016). A replacement of the TAVI valve by an “Edwards Intuity,
21mm” and a reconstruction of the aortic ring after explantation of the Direct Flow
prosthesis was performed. The final diagnosis was IE of the TAVI valve. The patient
was discharged to rehab 12 days after surgery. At a 4-month follow-up visit, the patient
was free of IE.
Conclusion: We learn, that once an operation is performed the surgeon is in charge, when procedure
or prosthesis-associated complications occur even in TAVI-patients. That despite the
calculated EuroSCORE values a surgical intervention has the potential to be successful
without much effort, especially due to an Intuity procedure. Due to the large number
of additional diseases in this patient a shorter procedure time, X-clamping time and
a reduction of manipulation should be the state of the art in such cases, those requirements
are likely possible by an Intuity replacement.
