Interv Akut Kardiol. 2013;12(1):43-46

Early prosthetic valve endocarditis requiring reconstructive reoperation - could it have been avoided?

Ingrid Porubčinová¹, Adrián Kolesár², Štefan Porubčin³, Ingrid Schusterová², Pavol Török¹, František Sabol²

¹ Klinika anesteziológie a intenzívnej medicíny VÚSCH a.s., Košice

² Klinika srdcovej chirurgie VÚSCH a.s., Košice

³ Klinika infektológie a cestovnej medicíny, UNLP, Košice

We present a case of a 34-year-old asymptomatic male who was admitted to the Department of Cardiac Surgery of Eastern Slovak Institute of

Cardiac and Vascular Diseases in Kosice for moderate aortic regurgitation in the region of the bicuspid aortic valve and dilatation of the ascending

aorta in order to receive surgical treatment. Due to an allergy to penicillin, the patient was given fluoroquinolone as part of short-term

antibiotic prophylaxis and, subsequently, underwent aortic valve replacement with a mechanical prosthesis. On the fourth post-operative day,

blood culture was obtained from the patient due to fever and methicillin-resistant S. epidermidis was found, which required a causal change

in antibiotic treatment. On the ninth post-operative day, TEE revealed vegetations attached to the mechanical prosthesis with dilatation of the

right heart chambers and tricuspid regurgitation. On the 14th post-operative day reoperation had to be performed. Due to a perioperative

finding of secondary Gerbode defect, it was necessary to perform pericardial repair of the LVOT, tricuspid valve annuloplasty, and replacement

of the aortic valve with a bioprosthesis. Our case highlights the immense importance of a proper choice of short-term antibiotic prophylaxis,

an early removal of catheters and cannulas and eradication of carriers of methicillin-resistant staphylococci in the prophylaxis of nosocomial

bloodstream infections as well as the importance of the correct timing of reoperation for early prosthetic valve endocarditis.

Keywords: prosthetic valve endocarditis, short-term antibiotic prophylaxis, reoperation

Published: February 21, 2013  Show citation