A 65-year-old man after the Bentall procedure (bioprosthesis Perimount 29 mm, Itergard 30 mm, 2018) was hospitalized due to aortic valve infective endocarditis. At admission, the patient complained about the deterioration of heart failure symptoms (up to New York Heart Association class IV) for 2 weeks. The C-reactive protein level was 18.36 mg/dL (normal < 0.5 mg/dL), the B-type natriuretic peptide level 12115 pg/mL (normal < 125 pg/mL), and troponin T 3502 ng/L (normal < 14 ng/L). Two-dimensional transthoracic echocardiography (TTE) revealed mobile echo-dense masses attached to the aortic prosthesis, dehiscence of the valvular prosthesis and its displacement towards the left ventricular outflow tract, severe aortic regurgitation, ascending aorta aneurysm (85 × 59 mm) and reduced left ventricular ejection fraction to 20%. Computed tomography (CT) confirmed prosthetic valve endocarditis. Moreover, CT showed pulmonary edema, bilateral pleural effusion (up to 4.3 cm on the right side, and 3.3 cm on the left side), and foci of splenic infarction. The patient underwent Bentall re-operation (conduit St.Jude 33 mm). Intraoperatively, vegetations around the aortic ring, non-coronary cusp perforation, and aneurysm of the aortic root (8–9 cm) were found. Blood and tissue prosthesis cultures which were obtained during that hospitalization, were negative. Six weeks of empirical antibiotic treatment was implemented. The postoperative TTE showed proper aortic prosthesis function with normal left ventricular ejection fraction. The patient was discharged from the hospital in good clinical condition.
The use of multimodality imaging in infective endocarditis diagnosis
Abstract
clinicAL CARDIOLOGY
IMAGE IN CADRIOVASCULAR MEDICINE
Cardiology Journal
2024, Vol. 31, No. 4, 645–646
DOI: 10.5603/cj.100016
Copyright © 2024 Via Medica
ISSN 1897–5593
eISSN 1898–018X
The use of multimodality imaging in infective endocarditis diagnosis
Address for correspondence: Michał Wrzosek, MD, Department of Valvular Heart Disease, National Institute of Cardiology, ul. Alpejska 42, 04–628, Warsaw, Poland, phone: +48 22 3434191, e-mail: mwrzosek@ikard.pl
Date submitted: 28.03.2024 Date accepted: 23.07.2024
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