Transcatheter Treatment of Patient With Mitral Valve Endocarditis and Severe Aortic Stenosis and Insufficiency.

BACKGROUND

Patients in cardiogenic shock secondary to endocarditis and multivalvular heart disease have a high surgical risk. Transcatheter valve aspiration followed by transcatheter valve intervention might be a strategy to salvage carefully selected patients.

CASE SUMMARY: A 63-year-old woman with subaortic membrane and severe aortic stenosis/regurgitation was scheduled for membrane resection, aortic root enlargement, and aortic valve replacement. Two weeks before operation, she developed mitral valve endocarditis. Because of cardiogenic shock, she was placed on venoarterial extracorporeal membrane oxygenation with a left atrial vent. Transcatheter aspiration of mitral vegetation resulted in minimal residual valve pathology with culture clearance; the patient received transcatheter aortic valve replacement and was discharged to a rehabilitation facility.

DISCUSSION: Surgery in patients with multivalvular disease with endocarditis and cardiogenic shock can be very high risk. Transcatheter aspiration of endocarditis and treatment of valvular disease might be an alternative to high-risk surgical therapy.

TAKE-HOME MESSAGES: Surgical treatment has been the only available option for patients with endocarditis and multivalvular disease. In these patients at very high operative risk and with appropriate valvular anatomy, transcatheter aspiration of endocarditis followed by transcatheter therapy of multiple valvular lesions can be feasible alternative.