Post-TAVI Infective Endocarditis: A Case Study

Introduction The incidence of infective endocarditis has risen significantly, with cases doubling over the past two decades. This condition is becoming more prevalent due to the growing accessibility of medical procedures with heart devices implantation and aging population[1]. Infective endocarditis remains a critical concern because of its challenging diagnosis, atypical presentations, and high mortality rates, which are up to 30 % rate at 30 days[2,3]. Case Presentation An 85-year-old male presented with fever, progressive weakness and shortness of breath for six months after transcatheter aortic valve implantation (TAVI). This was his third hospitalization in three months due to the same symptoms. His medical history included coronary artery bypass graft surgery, TAVI, type 2 diabetes mellitus, arterial hypertension, and congestive heart failure. During his first post-TAVI hospitalization, he was diagnosed with sepsis. Echocardiography showed no signs of infective endocarditis or complications. Blood cultures grew Enterococcus faecalis, and antibacterial treatment with Sultamicillin was initiated. He was discharged without a clear infection source. On his second admission, pneumonia was diagnosed and no echocardiography was performed. A month later, he was hospitalized again. Transesophageal echocardiography revealed vegetation on the prosthetic aortic valve, though function remained preserved. Repeat blood cultures confirmed Enterococcus faecalis, suggesting a diagnosis of infective endocarditis. Antibacterial treatment was restarted with Ampicillin and Gentamicin. After 19 days in a tertiary hospital, he was discharged to a secondary care facility to complete antibiotics. Discussion Infective endocarditis still is a rare complication, occurring in approximately 3.25% of cases after transcatheter aortic valve implantation surgery. In the first year after TAVI the risk of IE remains higher[5]. This complication is most commonly caused by enterococcal bacteria[4]. Therefore echocardiography and blood cultures tests remain crucial diagnosing infective endocarditis[5]. Conclusions This case illustrates a rare but serious complication after TAVI and the importance of targeted diagnosis and treatment.