A Case of Redo Aortic Valve Replacement for Bioprosthetic Aortic Valve Endocarditis Combined with Pyogenic Vertebral Osteomyelitis, Causing Prosthetic Valve Deterioration despite Effective Antibiotic Therapy
10.4326/jjcvs.44.87
- VernacularTitle:抗生剤が奏功するも生体弁破壊が進行した化膿性脊椎炎合併感染性心内膜炎に対する大動脈弁再置換術の1例
- Author:
Hitoshi Suhara
;
Toshiki Takahashi
;
Takashi Kido
;
Masaya Kainuma
- Publication Type:Journal Article
- Keywords:
vertebral osteomyelitis;
infective endocarditis;
aortic valve replacement;
antibiotics
- From:Japanese Journal of Cardiovascular Surgery
2015;44(2):87-91
- CountryJapan
- Language:Japanese
-
Abstract:
Infective endocarditis in association with pyogenic vertebral osteomyelitis is rarely observed. We report an 80-year-old man with infective endocarditis and pyogenic vertebral osteomyelitis requiring reoperation due to aortic prosthetic valve dysfunction. He suffered from back pain as the initial symptom, and he was admitted to our hospital. On magnetic resonance imaging, vertebral osteomyelitis was revealed, and antibiotics were started. On blood sampling α-streptococcus was identified and infective endocarditis was diagnosed. He responded to the antibiotic treatment. Despite the improvement in his general condition and the inflammatory parameters of blood samples, the aortic prosthetic valve dysfunction progressed. On echocardiography, aortic regurgitation worsened to 4/4, and the ejection fraction decreased from 72 to 46%. As heart failure was apparent, we performed a redo aortic valve replacement. Tears were found in the leaflets of the removed prosthetic valve (Hancock II). The 21-mm Carpentier-Edwards PERIMOUNT valve (CEP Magna Ease TFX) was replaced. His post-operative course was uneventful, and intravenous administration of ampicillin was continued. Oral rifampicin was also continued. On the 69th post-operative day, he was discharged and was ambulatory. Although we have no evidence that the tissue valve deterioration had resulted from bacterial damage, we were able to confirm that the structural valve deterioration involved bacterial contact in this case. Patients with infective endocarditis and pyogenic vertebral osteomyelitis should be treated cautiously regardless of whether or not the inflammation is controlled.
