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Int J Cardiol. 2018 Nov 15;271:392-395. doi: 10.1016/j.ijcard.2018.03.124.

Infective endocarditis following transcatheter aortic valve replacement: Diagnostic yield of echocardiography and associated echo-Doppler findings.

Author information

1
Department of Cardiovascular Medicine, Mayo Clinic, MN, United States. Electronic address: miranda.william@mayo.edu.
2
Department of Cardiovascular Medicine, Mayo Clinic, MN, United States.
3
Department of Cardiovascular Medicine, Mayo Clinic, MN, United States; Division of Infectious Diseases, Mayo Clinic, MN, United States.
4
Division of Infectious Diseases, Mayo Clinic, MN, United States.
5
Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, United States.

Abstract

BACKGROUND:

Studies have suggested the diagnostic yield of echocardiography to be lower in prosthetic valve endocarditis (PVE) after transcatheter aortic valve replacement (TAVR) than reported in surgically-implanted valves but data are limited.

METHODS:

We reviewed transthoracic (TTE) and transesophageal (TEE) echo-Doppler findings in 17 patients with PVE (13 definite and 4 possible cases according to modified Duke criteria) after TAVR at Mayo Clinic, Rochester, MN between 2007 and 2016.

RESULTS:

Median age was 81 years [56; 91] and 5 patients (29%) were female. Median Society of Thoracic Surgery predicted risk of mortality was 8.8%. PVE occurred 197 days [27; 923] after TAVR. Enterococcus faecalis was the most commonly encountered organism (29%). All patients had TEE performed at the time of PVE; TTE was performed in 11 patients. TEE was diagnostic for PVE in 47% of cases and TTE in 18%. TEE was diagnostic in 62% of patients if only definite PVE cases are included. Two patients showed prosthetic obstruction at the time of PVE; obstruction improved with antibiotic therapy in the surviving patient.

CONCLUSION:

Standard echocardiography techniques had limited diagnostic performance in patients with TAVR-related PVE. PVE can present as features of TAVR obstruction, thus PVE should also be considered in patients presenting with worsening prosthetic obstruction.

KEYWORDS:

Echocardiography; Endocarditis; Transcatheter aortic valve replacement

PMID:
30223376
DOI:
10.1016/j.ijcard.2018.03.124
[Indexed for MEDLINE]

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