Transcatheter aortic valve replacement associated infective endocarditis case series: broadening the criteria for diagnosis is the need of the hour

Abstract Background Transcatheter valve replacement (TAVR) is an important therapeutic intervention for patients with aortic valve stenosis. As TAVR has become available to a broader population, there has been an increase in the number of less common, yet potentially catastrophic, complications. TAV...

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Autores principales:	Kriti Lnu, Shamim Ansari, Shantanu Mahto, Hemal Gada, Mubashir Mumtaz, David Loran, Nikhil J. Theckumparapil, Amit N. Vora
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	TAVR Infective endocarditis Transcatheter aortic valve replacement Complications Prosthetic valve endocarditis Multi-modal imagining Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/2272199d5b504f7aa344b486beff0297
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spelling	oai:doaj.org-article:2272199d5b504f7aa344b486beff02972021-11-21T12:04:12ZTranscatheter aortic valve replacement associated infective endocarditis case series: broadening the criteria for diagnosis is the need of the hour10.1186/s12872-021-02364-01471-2261https://doaj.org/article/2272199d5b504f7aa344b486beff02972021-11-01T00:00:00Zhttps://doi.org/10.1186/s12872-021-02364-0https://doaj.org/toc/1471-2261Abstract Background Transcatheter valve replacement (TAVR) is an important therapeutic intervention for patients with aortic valve stenosis. As TAVR has become available to a broader population, there has been an increase in the number of less common, yet potentially catastrophic, complications. TAVR related infective endocarditis (TAVR-IE) is a rare, but potentially fatal, complication. Case series We present here two patients that we encountered for TAVR associated infective endocarditis. Our first patient presented 5 weeks after his TAVR. His initial presentation was consistent with signs of sepsis. The patient then developed Mobitz type I block during hospital course. His TEE was negative for features of infective endocarditis. Due to high suspicion, patient was taken for surgical exploration and was found to have multiple foci of vegetation adhered to the stent frame. Our second patient presented with new onset pulmonary edema, worsening heart failure and systemic inflammatory response. A TEE was done for persistent MSSA bacteremia which showed stable prosthetic valve function with no signs of infective endocarditis. Patient was discharged with a prolonged course of intravenous antibiotics. Patient was re-admitted for worsening sepsis and blood cultures were positive for MSSA. Patient was taken for surgical exploration of his prosthetic aortic valve which showed purulent aortic root abscess. Conclusion Through these cases, we aim to raise awareness on TAVR-IE. Due to the atypical clinical presentation, the modified Duke criteria may not be sufficient to diagnose TAVR-IE. Transesophageal echocardiogram in TAVR-IE may be negative or indeterminate. Prosthetic valve shadow may obscure smaller vegetations and/or smaller abscesses. A negative transesophageal echocardiogram should not rule out TAVR-IE and further diagnostic imaging modalities should be considered. PET/CT after administration of 18F-FDG (fluorodeoxyglucose) is a useful diagnostic tool in the diagnosis of infective endocarditis where TEE has been negative or inconclusive. Multi-modal imaging, in addition to the modified Duke criteria, can facilitate early diagnosis and improved mortality outcomes.Kriti LnuShamim AnsariShantanu MahtoHemal GadaMubashir MumtazDavid LoranNikhil J. TheckumparapilAmit N. VoraBMCarticleTAVRInfective endocarditisTranscatheter aortic valve replacementComplicationsProsthetic valve endocarditisMulti-modal imaginingDiseases of the circulatory (Cardiovascular) systemRC666-701ENBMC Cardiovascular Disorders, Vol 21, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	TAVR Infective endocarditis Transcatheter aortic valve replacement Complications Prosthetic valve endocarditis Multi-modal imagining Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	TAVR Infective endocarditis Transcatheter aortic valve replacement Complications Prosthetic valve endocarditis Multi-modal imagining Diseases of the circulatory (Cardiovascular) system RC666-701 Kriti Lnu Shamim Ansari Shantanu Mahto Hemal Gada Mubashir Mumtaz David Loran Nikhil J. Theckumparapil Amit N. Vora Transcatheter aortic valve replacement associated infective endocarditis case series: broadening the criteria for diagnosis is the need of the hour
description	Abstract Background Transcatheter valve replacement (TAVR) is an important therapeutic intervention for patients with aortic valve stenosis. As TAVR has become available to a broader population, there has been an increase in the number of less common, yet potentially catastrophic, complications. TAVR related infective endocarditis (TAVR-IE) is a rare, but potentially fatal, complication. Case series We present here two patients that we encountered for TAVR associated infective endocarditis. Our first patient presented 5 weeks after his TAVR. His initial presentation was consistent with signs of sepsis. The patient then developed Mobitz type I block during hospital course. His TEE was negative for features of infective endocarditis. Due to high suspicion, patient was taken for surgical exploration and was found to have multiple foci of vegetation adhered to the stent frame. Our second patient presented with new onset pulmonary edema, worsening heart failure and systemic inflammatory response. A TEE was done for persistent MSSA bacteremia which showed stable prosthetic valve function with no signs of infective endocarditis. Patient was discharged with a prolonged course of intravenous antibiotics. Patient was re-admitted for worsening sepsis and blood cultures were positive for MSSA. Patient was taken for surgical exploration of his prosthetic aortic valve which showed purulent aortic root abscess. Conclusion Through these cases, we aim to raise awareness on TAVR-IE. Due to the atypical clinical presentation, the modified Duke criteria may not be sufficient to diagnose TAVR-IE. Transesophageal echocardiogram in TAVR-IE may be negative or indeterminate. Prosthetic valve shadow may obscure smaller vegetations and/or smaller abscesses. A negative transesophageal echocardiogram should not rule out TAVR-IE and further diagnostic imaging modalities should be considered. PET/CT after administration of 18F-FDG (fluorodeoxyglucose) is a useful diagnostic tool in the diagnosis of infective endocarditis where TEE has been negative or inconclusive. Multi-modal imaging, in addition to the modified Duke criteria, can facilitate early diagnosis and improved mortality outcomes.
format	article
author	Kriti Lnu Shamim Ansari Shantanu Mahto Hemal Gada Mubashir Mumtaz David Loran Nikhil J. Theckumparapil Amit N. Vora
author_facet	Kriti Lnu Shamim Ansari Shantanu Mahto Hemal Gada Mubashir Mumtaz David Loran Nikhil J. Theckumparapil Amit N. Vora
author_sort	Kriti Lnu
title	Transcatheter aortic valve replacement associated infective endocarditis case series: broadening the criteria for diagnosis is the need of the hour
title_short	Transcatheter aortic valve replacement associated infective endocarditis case series: broadening the criteria for diagnosis is the need of the hour
title_full	Transcatheter aortic valve replacement associated infective endocarditis case series: broadening the criteria for diagnosis is the need of the hour
title_fullStr	Transcatheter aortic valve replacement associated infective endocarditis case series: broadening the criteria for diagnosis is the need of the hour
title_full_unstemmed	Transcatheter aortic valve replacement associated infective endocarditis case series: broadening the criteria for diagnosis is the need of the hour
title_sort	transcatheter aortic valve replacement associated infective endocarditis case series: broadening the criteria for diagnosis is the need of the hour
publisher	BMC
publishDate	2021
url	https://doaj.org/article/2272199d5b504f7aa344b486beff0297
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Transcatheter aortic valve replacement associated infective endocarditis case series: broadening the criteria for diagnosis is the need of the hour

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