P97 AORTIC PSEUDOANEURYSM AS PRESENTATION OF INFECTIVE ENDOCARDITIS FOLLOWING VALVE IN VALVE TAVR: THE IMPORTANCE OF A MULTIMODAL DIAGNOSTIC APPROACH

Abstract

Abstract Transcatheter aortic valve implantation complicated by infectious endocarditis (TAVI–IE) is an uncommon clinical event with a death rate of 24–46%. Despite several risk factors (young age, sex male, CKD, concurrent PM implantation, residual aortic insufficiency and valve–in–valve implantation) have been reported, the identification of this clinical scenario remains a diagnostic challange due to less sensivity and specificity of echocardiography ascribed to possible imaging artifacts or to a localization of the infectious process that cannot always be evalueted. Clinical case Sixty day after TAVI valve–in–valve procedure, during a rehabilitation recovery, an 80 years old female patient presented intermitted fever with an elevation of flogosis index. In suspicion of urinary tract infection, antibiotic therapy with ciprofloxacin has been started and at the same time the patient has been transferred to our center. At the admission time a blood colture resulted positive for Staphylococcus epidermidis. A complete echocardiogram(TTE+TEE) has been performed and showed an aortic bioprothesis with normal morphology, position and shape and normal gradient at continuos doppler analysis(17/30 mmHg). The distal part of the ascending aorta has not been evalueted due to a masking phenomenon caused by prostetich cage artifact. Considering the high probability of infective endocarditis, a chest CT was performed and showed a 22x11x18mm pseudoaneurism in the extreme distal point of the cranial part of the prosthesis. Therefore, the patient underwent to an emergency cardiac surgery with replacement of the ascending aorta with a prosthetic graft and the aortic valve with a new bioprothesis. The diagnosis of infected pseudoaneurysm was confirmed by the hystologic examination and after 22 days since the intervention, the patient was transferred to the sending rehabilitation center with an indication to continue Daptomicin therapy, started during the recovery, for 6 weeks. Even with non–suggestive ecocardiographic evidence, the presence of positive blood colture test in patients with endocarditis risk factors, need a multimodal imaging approach to diagnosis (for instance, CT or PET) in order to provide prompt and appropriate therapy.