195 INFECTIVE ENDOCARDITIS POST-TRANSCATHETER AORTIC VALVE IMPLANTATION (TAVI) WITH SYSTEMIC EMBOLIZATION TREATED WITH MEDICAL THERAPY

Post-TAVI infective endocarditis is a rare event. The incidence is 3,25%, and it is associate with severe complications and high risk of mortality.

The aim of the study is to focus on the possibility of alternative therapy except surgery in treatment of a complicated endocarditis, choice taken also thanks to TEE, through it is possible analyze the integrity of the prosthesis, evidence/absence of rupture or ulceration and monitoring the evolution during therapy.

A 76-year-old female patient who went to TAVI, reported fever, increased phlogosis indices and abdominal pain few days after the procedure. Diagnostic imaging resulted in infection of the aortic prosthesis and in thromboembolisms affecting splenic artery and celiac trunk. At TEE an isoechogenic vegetation (14×8 mm) was described in correspondence of aortic prothesis and high gradient was detected. Thromboembolic events have occurred and thrombo-endoarteriectomia of right femoral artery was performed. Staphylococcus Lugdunensis was found in blood cultures and intravenous antibiotic and anticoagulant therapy was undertaken.

After one month of medical therapy, at TEE significant vegetation reduction was found. Patient was discharged at home, asymptomatic. After 1 month at TTE no sign of endocarditis was detected, blood sample was fine and patient was asymptomatic.

This case is an example of an early infective process involving biological valve post-TAVI, followed by systemic embolization, in which the only medical therapy was successful. Echocardiography has played a fundamental role to choose the strategy of therapy and to monitor its result.