Rapid diagnosis of prosthetic valve endocarditis from Janeway lesions in a transcatheter aortic valve implantation patient

Abstract

Percutaneous transcatheter aortic valve implantation (TAVI), first introduced in 2002, is a viable solution for previously inoperable or high-risk patients with aortic stenosis, providing the benefit of valve replacement without the associated risks of surgery. When these patients develop prosthetic valve endocarditis (PVE), management is complicated, owing to their often, atypical presentations and baseline comorbidities. Moreover, it is often difficult to detect vegetations in such patients, even with transesophageal echocardiography. Here, we describe a case of post-TAVI PVE that was successfully treated medically after a rapid diagnosis was made based on physical examination. Our experience shows that physical examination continues to be important for rapid diagnosis of infective endocarditis, even in the era of structural heart disease intervention.<Learning objective: Diagnosis of endocarditis in transcatheter aortic valve implantation patients can be difficult and may be delayed, as echocardiography is often inconclusive because of the unique physiology of these patients. We should maintain a low threshold for investigation of infective endocarditis in these patients, and more emphasis should be placed on physical examination to ensure rapid diagnosis and favorable clinical outcome.>