Post-cardiac catheterization infective endocarditis with flail mitral valve leaflets: an interesting and rare case

Abstract

Endocarditis is a life-threatening infection of the endocardium (inner lining of the heart). It usually affects the left-sided valves more than the right-sided valves and presents classically with a new murmur, fever, and peripheral stigmata. Though in the modern era, we have better antibiotics, better diagnostic imaging, and surgery that might cure infectious endocarditis (IE), it still carries significant mortality and morbidity. Here we present a 52-year-old male patient with hypertension and ischemic heart disease who presented with shivering, fever, and confusion for 2 days, fourteen days after cardiac intervention (PCI). Further trans-esophageal echocardiography was done due to the patient’s fulfillment of three minor and one major of Duke's criteria. Trans-esophageal echocardiography revealed flailing posterior mitral valve leaflets, 1.1 x 0.60 cm of vegetation, and severe eccentric mitral regurgitation. The patient was managed with vancomycin and gentamicin and referred to the cardiovascular surgery center. Post-PCI infective endocarditis is a rare and often missed diagnosis, so there should be a high level of suspension for those who present with signs and symptoms compatible with infective endocarditis.

Pseudoaneurysm Infection Ballooning Out of Control Following Sequential Cardiac Catheterizations: A Case Report

“…Infection is a well-known risk of access for endovascular procedures and indwelling lines [ 3 ]. The use of appropriate sterile technique, as occurs during cardiac catheterization, has made the development of bacteremia a rare complication but has not eliminated the risk [ 4 ]. PSA formation is also a possible complication due to the disruption of the arterial wall at the access site, as seen in this case.…”

“…In cases where coronary artery disease has been ruled out, other causes of chest pain, such as musculoskeletal pain or gastrointestinal disorders, should be considered. If catheterization is necessary, the procedure's risks and benefits should be carefully weighed, especially in patients who have already undergone multiple catheterizations [ 4 ]. Infection control measures during endovascular procedures are essential to minimizing the possibility of bacteremia development, including preoperative bathing, perioperative access site cleansing, and rigid adherence to sterile technique during the procedure [ 11 ].…”