title: With the back against the wall: TAVI in a patient with endocarditis.
abstract: Transcatheter Aortic Valve Implantation (TAVI) is currently a well-established therapeutic option in patients with severe aortic stenosis considered at prohibitive risk for open heart aortic valve replacement (Cribier et al., Circulation 2002;106:3006-3008; Leon et al., Semin Thorac Cardiovasc Surg 2006;18:165-174). We report a case of a patient with endocarditis by severe homograft aortic stenosis for which a TAVI procedure was performed with an excellent result. The patient was undergoing a presurgery standard screening in preparation for a planned aortic valve replacement operation when he developed a Staphyloccocus aureus sepsis. Transoesophageal echocardiography demonstrated an aortic valve vegetation. A few days later, the patient developed a stroke probably due to embolization of a vegetation. Given the clinical severity of the case a standard open heart aortic valve replacement was considered too risky and the patient underwent a TAVI procedure. Postintervention the patient had a spectacular evolution with fast normalization of the septic shock parameters and clinical status. Antibiotics were continued for a total of nine weeks. By the ambulatory controls at three weeks, two months and six months postdischarge, the patient was completely asymptomatic and his echocardiography showed a normally functioning aortic valve without indications of endocarditis.
authors.affiliation: Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, Nieuwegein, the Netherlands.
authors.forename: Ciprian
authors.initials: C
authors.lastname: Albu
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Swaans
authors.forename: Jurien M
authors.initials: JM
authors.lastname: ten Berg
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001024:Aortic Valve Stenosis / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D006328:Cardiac Catheterization; D017548:Echocardiography, Transesophageal; D004617:Embolism / Q000209:etiology; D004697:Endocarditis, Bacterial / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors; D012772:Shock, Septic / Q000209:etiology; D013203:Staphylococcal Infections / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents