title: Prosthetic aortic valve: a bone in the system.
abstract: We report a case of a 73-year-old female patient admitted to the surgical department for a splenic abscess. She had a history of a mechanical aortic valve implanted two years earlier. During the diagnostic work-up, the patient underwent a transesophageal echocardiogram that revealed the presence of multiple paravalvular abscesses, establishing the diagnosis of prosthetic valve endocarditis. A few days later, the echocardiogram was repeated due to a new-onset systolic-diastolic murmur. A large pseudoaneurysm and significant periprosthetic regurgitation were now noted and the patient was referred for cardiac surgery. The microbiologic exam revealed the presence of Streptococcus milleri, usually found in the gastrointestinal flora and a known pathogenic agent of endocarditis. Interestingly, the patient had had a foreign body (bone fragment) removed from her esophagus a few weeks earlier, which was the probable portal of entry for this infective endocarditis.
authors: Cardiology Department, Alto Ave Hospital Center, Guimarães, Portugal; Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal. Electronic address: pereira.vitorhugo@gmail.com.
authors: Vitor Hugo
authors: VH
authors: Pereira
authors: Cardiology Department, Alto Ave Hospital Center, Guimarães, Portugal.
authors: Joana
authors: J
authors: Guardado
authors: Cardiology Department, Alto Ave Hospital Center, Guimarães, Portugal.
authors: Marina
authors: M
authors: Fernandes
authors: Cardiology Department, Alto Ave Hospital Center, Guimarães, Portugal.
authors: Mário
authors: M
authors: Lourenço
authors: Cardiology Department, Alto Ave Hospital Center, Guimarães, Portugal.
authors: Inocência
authors: I
authors: Machado
authors: Cardiology Department, Alto Ave Hospital Center, Guimarães, Portugal.
authors: Isabel
authors: I
authors: Quelhas
authors: Cardiology Department, Alto Ave Hospital Center, Guimarães, Portugal.
authors: Olga
authors: O
authors: Azevedo
authors: Cardiology Department, Alto Ave Hospital Center, Guimarães, Portugal.
authors: António
authors: A
authors: Lourenço
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D004697:Endocarditis, Bacterial / Q000209:etiology*; D005260:Female; D005547:Foreign Bodies / Q000150:complications*; D006350:Heart Valve Prosthesis; D006801:Humans; D013290:Streptococcal Infections / Q000209:etiology*; D034364:Streptococcus milleri Group
keywords: Abcessos; Abscesses; Endocardite infecciosa; Infective endocarditis; Prosthetic aortic valve; Prótese valvular nórtica; Pseudoaneurisma; Pseudoaneurysm; Streptococcus milleri