Paravalvular Abscess as a Complication of Streptococcus Salivarius Infective Endocarditis of a Bioprosthetic Aortic Valve.

Abstract

Rates of implantation of prosthetic valves and cardiac devices have increased significantly in the last thirty years, accounting, at least in-part, for the growing incidence of infective endocarditis cases. Prosthetic valve endocarditis (PVE) is an endovascular, microbial infection occurring on parts of a valve prosthesis or on reconstructed native heart valves. We present a case of a 63-year-old man with multiple comorbidities including extensive cardiovascular disease, who recently underwent bioprosthetic aortic valve replacement. Patient presented to the emergency department with exertional chest pain, dyspnea, fever, melena and lethargy. Blood cultures grew Streptococcus salivarius and transesophageal echocardiography confirmed PVE with an aortic paravalvular abscess. The patient was treated with appropriate antimicrobial therapy based on culture sensitivity and subsequently referred to cardiothoracic surgery for urgent evaluation. This case highlights several important points which include but are not limited to: investigation into the pathogen Streptococcus salivarius and its relationship to other known pathogens, understanding of the complications associated with PVE, and the importance of early identification of PVE and initiation of medical and surgical therapy with respect to prognosis.