Case
We report the case of a 65-year-old man with a history of severe aortic
stenosis and aortic prosthetic valve replacement. Pre-surgical coronary
angiography showed no significant obstructions, and other comorbidities
were discarded. The patient recovered without complications and was
discharged home with anticoagulant treatment. One month after surgery,
he arrived at the emergency department complaining of sudden oppressive
retrosternal chest pain and dyspnea. On physical examination, his heart
rate was 74 beats per minute, he was found to be diaphoretic,
hypotensive, and tachypneic with 96% oxygen saturation. Thoracic
examination revealed no rales and prosthetic valve sounds without
murmurs. His leukocyte, glucose, troponin, and B-type natriuretic
peptide (BNP) levels were 8.5x109/L, 143g/dL, 120ng/ml and 659pg/mL,
respectively. The initial electrocardiogram showed anterolateral
ST-segment elevation myocardial infarction (STEMI). Emergency
coronariography was performed, revealing proximal left anterior
descending (LAD) artery embolic occlusion, and coronary balloon
angioplasty was successfully performed. (Figure 1)
During recovery, the patient presented with fever; blood cultures were
taken, and empirical vancomycin was initiated. Transthoracic
echocardiography (TTE) showed normal prosthetic function and no
vegetation. Blood cultures were negative, and clinical evolution was
satisfactory, so he was discharged home. The patient was readmitted to
the emergency department three weeks later with fever, cardiogenic
shock, and complete atrioventricular block, so a temporal pacemaker was
placed. Upon physical examination, a new aortic systolic murmur was
auscultated without prosthetic click sounds. Urgent TTE revealed 14 x 15
mm vegetation at the prosthetic aortic valve. Septic and cardiogenic
shock were diagnosed and attributed to infective endocarditis. The
patient experienced cardiac arrest and died a few hours later, despite
aggressive management. The postmortem pathology report
confirmedĀ Aspergillus ssp , prosthetic aortic valve endocarditis,
and anterolateral myocardial infarction. (Figure 2)