title: Prosthetic valve endocarditis with valvular obstruction after transcatheter aortic valve replacement.
abstract: Patients with severe aortic stenosis who are at high risk for open-heart surgery might be candidates for transcatheter aortic valve replacement (TAVR). To our knowledge, this is the first report of Streptococcus viridans endocarditis that caused prosthetic valve obstruction after TAVR. A 77-year-old man who had undergone TAVR 17 months earlier was admitted because of evidence of prosthetic valve endocarditis. A transthoracic echocardiogram revealed a substantial increase in the transvalvular peak gradient and mean gradient in comparison with an echocardiogram of 7 months earlier. A transesophageal echocardiogram showed a 1.5-cm vegetation obstructing the valve. Blood cultures yielded penicillin-sensitive S. viridans. The patient was hemodynamically stable and was initially treated with vancomycin because of his previous penicillin allergy. Subsequent therapy with levofloxacin, oral penicillin (after a negative penicillin skin test), and intravenous penicillin eliminated the symptoms of the infection. Transcatheter aortic valve replacement is a relatively new procedure, and sequelae are still being discovered. We recommend that physicians consider obstructive endocarditis as one of these.
authors: Christine
authors: C
authors: Pabilona
authors: Bernard
authors: B
authors: Gitler
authors: Jeffrey A
authors: JA
authors: Lederman
authors: Donald
authors: D
authors: Miller
authors: Theodore N
authors: TN
authors: Keltz
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000382:microbiology*; D004696:Endocarditis / Q000150:complications* / Q000188:drug therapy; D006349:Heart Valve Diseases / Q000209:etiology*; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D016459:Prosthesis-Related Infections; D013290:Streptococcal Infections / Q000188:drug therapy / Q000209:etiology*; D065467:Transcatheter Aortic Valve Replacement; D034363:Viridans Streptococci
keywords: Anti-bacterial agents/therapeutic use; aortic valve stenosis/complications/therapy; aortic valve/surgery; endocarditis, bacterial/diagnosis/therapy; heart valve prosthesis implantation/adverse effects/methods; postoperative complications; prosthesis-related infections/drug therapy; treatment outcome