Fulminant periannular destruction after valve-in-valve transcatheter aortic valve implantation unmasking advanced HIV infection

Structural valve deterioration (SVD) is a recognized limitation of bioprostheses, often manifesting 10-15 years post-implantation [1].Valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) is increasingly utilized for failed bioprostheses in patients at elevated surgical risk [2].Infective endocarditis (IE) following TAVI, albeit uncommon, carries grave prognostic implications and complex diagnostic / therapeutic challenges [3].A 61-year-old man, 11 years after surgical aortic valve replacement (Perimount Magna 25) for severe aortic regurgitation, presented with progressive exertional dyspnea (NYHA III).