Prosthetic valve endocarditis (PVE) after Transcatheter Aortic Valve Implantation (TAVI) has been reported to occur with an incidence of 0.3%–3.1% per patient-year and it is associated with high mortality rates. We report a PVE occurring early, i.e., 26 days post transfemoral TAVI with the use of Edward-Sapien-XT S3 prosthesis 26 mm because of severe symptomatic aortic stenosis. His past medical history included a coronary and peripheral arterial disease and a total knee replacement in 2010. Our patient, a 77-year old female, was admitted with signs of septic arthritis of the left knee and was febrile. Biochemistry revealed elevated C-reactive protein (24 mg/dL) indicative of an ongoing inflammatory process. The patient was operated urgently and the endoprosthesis was explanted. Blood cultures demonstrated Staphylococcus aureus. On transesophageal echocardiography (TOE), a floating mobile mass was detected which was attached on aortic bioprosthesis and also a satellite-endocarditis of the mitral valve and the aortomitral continuity (Figures1A & B). Initial, there was no evidence for mycotic aneurysm, fistula or abscess formation.
High-dose antibiotic therapy was administered intravenously consisting of Flucloxacillin and gentamycin for six weeks and one week, respectively. Due to high surgical risk with logistic EuroSCORE II of 18.79% and after consultation with the Heart Team, Conservative treatment was followed.
In the next three weeks, a repeat TOE showed a further extension of endocarditis-lesions with mitral valve involvement, formation of a new abscess cavity and a rupture with fistula between aortic annulus and left atrium. The mitral regurgitation increased without any difference on aortic regurgitation. (Figures1C, D, E, F).