What is it about?
We report a case of an 83-years-old woman presenting with heart failure and fever after TAVI. Clinical diagnosis of definitive infective endocarditis was performed. Surprisingly, histopathologic analysis after aortic valve replacement demonstrated a massive degeneration of the prosthesis, coexisting with signs of subacute endocarditis.
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Why is it important?
Transcatheter heart valve (THV) failure is an emerging condition that may occur after transcatheter aortic valve implantation (TAVI). Although echocardiography is a reliable tool for diagnosis of THV dysfunction, echocardiographic definition of each failure mode (endocarditis, thrombosis, leaflets degeneration) can be challenging. This report suggests that bioprosthetic structural degeneration may be under-diagnosed, especially when multiple conditions coexist.
Perspectives
TAVI is the standard of care to treat high-surgical-risk patients with aortic stenosis and it is now gaining ground as an alternative to surgical aortic valve replacement in middle-risk patients. Nevertheless transcatheter heart valve (THV) early degeneration may limit this process. Further investigations including histopathologic and molecular analysis, are needed to better understand the pathogenic mechanisms of such degeneration and to ensure the longest possible THV durability.
Dr Marco Spartera
Universita Vita Salute San Raffaele
Read the Original
This page is a summary of: Early degeneration and endocarditis in a transcatheter heart valve, European Heart Journal, May 2016, European Society of Cardiology,
DOI: 10.1093/eurheartj/ehw174.
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