J Cardiovasc Ultrasound.  2014 Sep;22(3):134-138. 10.4250/jcu.2014.22.3.134.

Infective Endocarditis Associated with Transcatheter Aortic Valve Replacement: Potential Importance of Local Trauma for a Deadly Nidus

• Lee HS
• Lee SP
• Jung JH
• Kim HM
• Kim CH
• Park JB
• Kim HK
• Kim YJ
• Kim HS
• Sohn DW

• KMID: 2045429
• DOI: http://doi.org/10.4250/jcu.2014.22.3.134

Abstract

Recently, transcatheter aortic valve replacement (TAVR) has emerged as an alternative for the treatment of severe symptomatic aortic stenosis patients. Although experience with TAVR is increasing exponentially, few cases of post-TAVR endocarditis are reported. We present a case of 76-year-old man with infective endocarditis after TAVR who was definitely diagnosed by echocardiography.

Keyword

Transcatheter aortic valve replacement; Infective endocarditis

MeSH Terms

Aged
Aortic Valve Stenosis
Aortic Valve*
Echocardiography
Endocarditis*
Humans

Figure

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  Fig. 1 Transthoracic echocardiography images before and after transcatheter aortic valve replacement (TAVR). A and B: Apical 5-chamber views with color Doppler images. C and D: Parasternal short-axis views of the aortic valve. E and F: Continuous wave Doppler of aortic valve. A, C, and E: Before TAVR. B, D, and F: After TAVR.

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  Fig. 2 Angiographic image just after transcatheter aortic valve replacement. The device was implanted 6-8 mm deep into the left ventricle, which demonstrates the adequacy of implantation per manufacturer's recommendation.

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  Fig. 3 A: Simple chest X-ray revealed bilateral pleural effusion. B: 12-lead electrocardiogram showed atrial fibrillation with rapid ventricular response and left bundle branch block.

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  Fig. 4 Transthoracic and transesophageal echocardiography (TEE) images of the aortic valve at the time of diagnosis of infective endocarditis. A: Parasternal long-axis images of the mitral valve. Significant mitral regurgitation can be seen just beneath the strut of the bioprosthetic aortic valve (green arrow). B: TEE images show that the vegetation (blue arrow) is located just at the ventricular side of the aortic valve bioprosthesis with subsequent perforation of the anterior mitral valve. There is also thickening of the aortomitral continuity (red arrow) suggestive of abscess due to endocarditis.

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  Fig. 5 Noncontrast computed tomography of the brain showing cortical intracranial hemorrhage (arrows), along the left high central and parietal sulci.

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