Recurrent endocarditis in silver-coated heart valve prosthesis.
OBJECTIVE
In order to prevent prosthetic valve endocarditis (PVE), the implantation of a new silver-coated sewing ring has been introduced to provide peri- and postoperative protection against microbial infection.


METHODS
A 56-year-old woman with aortic stenosis had elective replacement with a St. Jude Medical mechanical valve fitted with a silver-coated sewing ring (Silzone). The patient developed early PVE, which necessitated reoperation after one month. Despite a second Silzone prosthesis being implanted, the endocarditis recurred. During a third operation an aortic homograft was implanted, and after six months a fourth operation was performed for a pseudoaneurysm at the base of the homograft, in proximity to the anterior mitral valve leaflet.


RESULTS
The diagnosis of PVE was confirmed by the presence of continuous fever, transesophageal echocardiography and growth of penicillin-resistant Staphylococcus epidermidis from the valve prosthesis.


CONCLUSIONS
The implantation of all prosthetic valves is encumbered with a risk of endocarditis. Although silver has bacteriostatic actions, the advantages of silver-coated prostheses in the treatment of this condition have yet to be assessed in clinical trials.
Kjaergard
H K
HK
Department of Cardiothoracic Surgery, Gentofte Hospital, University of Copenhagen, Denmark.
Tingleff
J
J
Abildgaard
U
U
Pettersson
G
G
D000900:Anti-Bacterial Agents; D001024:Aortic Valve Stenosis / Q000601:surgery; D020099:Coated Materials, Biocompatible / Q000009:adverse effects*; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D017548:Echocardiography, Transesophageal; D004697:Endocarditis, Bacterial / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D012008:Recurrence; D012086:Reoperation; D012834:Silver; D013203:Staphylococcal Infections / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D013212:Staphylococcus epidermidis / Q000302:isolation & purification
D000900:Anti-Bacterial Agents; D020099:Coated Materials, Biocompatible; D012834:Silver