Fatal Lactobacillus endocarditis in a patient with transcatheter aortic valve replacement

Lactobacillus species may translocate from the gastrointestinal tract into systemic circulation from ingested probiotics or commensal flora. Their pathogenic potential is still debated. Lactobacillus endocarditis is a rare entity with only around 120 cases reported in the literature. Here, we report the first case of fatal Lactobacillus endocarditis with involvement of a transcatheter aortic valve replacement with the following goals: to reaffirm the pathological significance of Lactobacillus spp, to demonstrate the potential limitations of the modified Duke criteria in diagnosing infective endocarditis of transcatheter aortic valve replacement, and to urge clinicians to aggressively search for and consider empiric treatment for endocarditis in patients with prosthetic valves who develop Lactobacillus bacteraemia.

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Lactococcus garvieae: An Uncommon Human Pathogen Causing Infective Endocarditis in a Valve-in-Valve Transcatheter Aortic Valve Replacement

Case Reports in Cardiology ◽

10.1155/2021/5569533 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Diego H. González-Bravo ◽

Sergio Alegre-Boschetti ◽

Richard Silva-Cantillo ◽

Joshua Mercado-Maldonado ◽

Reyshley Ramos-Márquez ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Current Knowledge ◽

Lactococcus Garvieae ◽

Transcatheter Aortic Valve ◽

First Case ◽

Duke Criteria ◽

Valve In Valve

Lactococcus garvieae is a fish pathogen and an uncommon cause of human infections. There is a growing body of evidence showing its potential for causing endocarditis especially in those with prior valve surgery. In this case report, we present what we believe is the first case of endocarditis by L. garvieae affecting a valve-in-valve transcatheter aortic valve replacement that was successfully treated. Specific guidelines for the management of these patients are lacking. Our experience can contribute to the current knowledge regarding this life-threatening infection as well as to the future care of these patients. We aim to emphasize that despite not being recognized as a typical endocarditis microorganism by the Duke Criteria, the possibility of endocarditis needs to be highly entertained in patients with L. garvieae bacteremia, especially when prosthetic valves are present. Consequently, clinicians should pursue further this diagnosis with transesophageal echocardiogram and/or alternative imaging modalities (e.g., PET-CT scan and MRI) regardless of an initial negative transthoracic echocardiogram. Reaching a diagnosis of L. garvieae endocarditis led us to the decision of prolonging the antibiotic course for 6 weeks with successful results. Ultimately, surgery was not required owing to the absence of prosthetic aortic valve dysfunction and paravalvular extension of the infection.

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Systemic Thrombolytic Therapy for Stroke After Transcaval Transcatheter Aortic Valve Replacement

Journal of the Minneapolis Heart Institute Foundation ◽

10.21925/mplsheartjournal-d-18-00012.1 ◽

2018 ◽

Vol 2 (2) ◽

pp. 31-33

Author(s):

Steven Smedhammer ◽

Matt Glogoza ◽

Cornelius Dyke ◽

Thomas Haldis

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Thrombolytic Therapy ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Transcatheter Aortic Valve ◽

First Case ◽

Amplatzer Device ◽

Systemic Thrombolytic Therapy ◽

Tissue Plasminogen

An 80-year-old male with aortic stenosis underwent transcatheter aortic valve replacement through a transcaval approach. The aorta was closed with an Amplatzer device without retroperitoneal leak or fistula. The patient developed a stroke three hours after the procedure and was treated with tissue plasminogen activator. Imaging after thrombolytic therapy revealed no aortic extravasation from the puncture site. To our knowledge, this demonstrates the first case in which thrombolytic therapy was used after transcaval access to the abdominal aorta for transcatheter aortic valve replacement and suggests that patients without leak after transcaval aortic closure, thrombolytic therapy is not contraindicated.

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