Recurrent Prosthetic Valve Endocarditis With Aortomitral Curtain Destruction in an Elderly Patient.

BACKGROUND

Recurrent prosthetic valve infective endocarditis in older adults can present atypically and progress rapidly, requiring complex decisions.

CASE SUMMARY: A 69-year-old man with prior bioprosthetic aortic and mitral valve replacement presented with progressive back pain without fever. Blood cultures grew Enterococcus faecalis. Transesophageal echocardiography showed large vegetations on both prostheses with periannular extension and an aortic root abscess. Despite intravenous ampicillin plus ceftriaxone, inflammatory markers and vegetation burden increased, prompting Endocarditis Team-recommended urgent redo surgery. Complete destruction of the intervalvular fibrosa required radical debridement, double valve replacement, and reconstruction of the aortomitral continuity (Commando procedure). The patient completed 6 weeks of targeted therapy; dental evaluation revealed advanced chronic periodontitis as the likely source.

DISCUSSION: Uncontrolled prosthetic valve endocarditis warrants repeat imaging and timely multidisciplinary surgical management, even in elderly patients.