Unusual Mechanism of Myocardial Infarction in Prosthetic Valve Endocarditis

Abstract

A 46-year-old man presented with a history of dyspnea and fatigue exacerbated by a recent hospitalization related to pulmonary edema. The diagnosis was confirmed by echocardiography, which revealed the presence of a bicuspid aortic valve with a mixed lesion, predominantly stenotic. The patient was submitted to aortic valve replacement with a stented bioprosthesis. The operation and his postoperative recovery were uneventful. He developed Staphylococcus epidermidis prosthetic valve endocarditis a month later, presenting in the emergency room with acute myocardial infarction. The mechanism of myocardial ischemia was a large aortic root abscess causing left main extrinsic compression. He was urgently taken to the operating room, and an aortic root replacement with cryopreserved homograft was performed, associated with autologous pericardium patch closure of aortic-to-right-atrium fistula and coronary artery bypass grafting of the left anterior descending. After a difficult postoperative period with multiple problems, he was eventually discharged home 6 weeks after surgery in good condition, with no signs of active infection. At 36-month follow-up, he is asymptomatic, currently in New York Heart Association functional class I, with no recurrent infection, ventricular function is normal, and the left main is widely patent, and the saphenous vein graft is occluded on control chest computed tomography.