Unusual mechanism of myocardial infarction in prosthetic valve endocarditis

Abstract

Fernando A Atik,1 Vanessa G Campos,2 Claudio R da Cunha,1 Felipe Bezerra Martins de Oliveira,1 Maria Estefânia Bosco Otto,2 Guilherme U Monte,2 1Department of Cardiovascular Surgery, Instituto de Cardiologia do Distrito Federal, Fundação Universitária de Cardiologia, Brasília, Distrito Federal, Brazil; 2Department of Cardiovascular Medicine, Instituto de Cardiologia do Distrito Federal, Fundação Universitária de Cardiologia, Brasília, Distrito Federal, Brazil Abstract: A 46-year-old man with bicuspid aortic valve and severe calcific aortic stenosis was submitted to aortic valve replacement with a stented bioprosthesis. 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. At 36-month follow-up, he is asymptomatic with no recurrent infection, and the left main coronary artery is widely patent on control chest computed tomography. Keywords: aortic root, endocarditis, aortic valve replacement, heart valve, allograft