An unusual case report of transcatheter aortic valve implantation-related actinomycosis endocarditis. Issue 8 (28th August 2022)

• Record Type: Journal Article
• Authors: Gurevitz, Chen; Rubchevsky, Victor; Hamdan, Ashraf; Orvin, Katia
• Editors: Pavasini, Rita; Yahia, Faten; Karamasis, Grigoris; Abdelfattah, Omar; Fawzy, Ameenathul Mazaya
• Is Part Of: European heart journal. Volume 6:Issue 8(2022)
• Publication Date: 2022-08-28
• Subjects: Case reports -- Endocarditis -- Transcatheter aortic valve implantation -- Actinomycosis; Cardiology -- Periodicals; Cardiology -- Case studies -- Periodicals; Heart -- Diseases -- Periodicals; Heart -- Diseases -- Case studies -- Periodicals; 616.12
• DOI: 10.1093/ehjcr/ytac302
• Languages: English
• ISSNs: 2514-2119

Abstract

Abstract: Background: Actinomycosis is a chronic invasive infection caused by Actinomyces species. Actinomycosis endocarditis has been described, yet considered rare. We present the first reported transcatheter aortic valve implantation (TAVI)-related actinomycosis endocarditis. Case summary: A 70-year-old female patient, presented 4 months after TAVI with malaise and vocal-cord paralysis. She underwent computed tomography angiography which demonstrated a 28 mm pseudoaneurysm of the ascending aorta, which compressed the laryngeal nerves. Her condition rapidly deteriorated with cardiogenic shock and required an emergent surgery, which reviled a tamponade with active bleeding, due to an ascending aortic dissection. She underwent aortic valve and ascending aorta replacement. A 2 cm vegetation was found on the TAVI prosthetic valve and sent for cultures, which later revealed an Actinomyces neuii infection. Long-term intravenous ampicillin treatment was given. Discussion: This case describes a patient with endocarditis on TAVI prosthetic valve, with an unusual clinical presentation and rapid deterioration to an emergency intervention. This unique presentation of tumour-like tissue invasion is characteristic of actinomycosis, and should be suspected especially following valve replacement.