Diagnostic dilemma in prosthetic valve endocarditis: Computed tomography to the rescue

J Card Surg. 2019 Apr;34(4):208-210. doi: 10.1111/jocs.14001. Epub 2019 Feb 25.

Abstract

A 58-year-old man with multiple myeloma, prior bioprosthetic valve, spinal hardware and multiple episodes of Corynebacterium amycolatum bacteremia was found to have a well-seated valve without vegetations, paravalvular leak, abscess or degeneration over a period of 6 months on five separate transesophageal echocardiographic studies. Computed tomography angiography was performed which revealed vegetation at the level of the left ventricular outflow tract. Reoperative sternotomy and interrogation of the valve confirmed a 1.5-cm vegetation with the same bacterium. The patient underwent a redo aortic valve replacement and recovered without any complications. He has been asymptomatic and culture negative on surveillance.

Keywords: aorta and great vessels; cardiovascular pathology; endocarditis.

Publication types

  • Case Reports

MeSH terms

  • Aortic Valve / surgery*
  • Aortic Valve Stenosis / surgery*
  • Bioprosthesis / adverse effects*
  • Corynebacterium
  • Corynebacterium Infections
  • Endocarditis / diagnostic imaging*
  • Endocarditis / etiology
  • Endocarditis / microbiology
  • Endocarditis / surgery*
  • Equipment Failure Analysis
  • Heart Valve Prosthesis / adverse effects*
  • Heart Valve Prosthesis Implantation*
  • Humans
  • Male
  • Middle Aged
  • Prosthesis Failure / adverse effects*
  • Reoperation
  • Sternotomy
  • Tomography, X-Ray Computed*
  • Treatment Outcome