Cor Vasa 2025, 67(Suppl.3):24-27 | DOI: 10.33678/cor.2025.021

A multifaceted prosthetic valve infective endocarditis

Mario Di Marino^a, b†, Eugenio Genovesi^b†, Alessandro Corazzini^b, Roberta Magnano^b, Alberto D'Alleva^b, Sabina Gallina^a, Massimo Di Marco^b

^a Department of Neuroscience, Imaging and Clinical Sciences, G. D'Annunzio University of Chieti-Pescara, 66100 Chieti, Italy

^b Cardiology and ICCU Department, Santo Spirito Hospital, 65124 Pescara, Italy ^† These authors contributed equally to this work.

Infective endocarditis is a significant public health challenge, with high mortality and morbidity. A 79-year-old man, post-aortic bioprosthetic implantation, presented with chest pain. An electrocardiogram indicated anterior ST-elevation myocardial infarction. Urgent coronary angiography showed critical left anterior descending artery stenosis, treated with angioplasty and a drug-eluting stent. Transthoracic and transesophageal echocardiograms revealed nosocomial endocarditis on the aortic bioprosthetic and a significant peri-prosthetic abscess. Blood cultures identified multidrug-resistant Staphylococcus haemolyticus. Despite surgical recommendations, the patient opted for intra-hospital antibiotic therapy and home care after repeated transesophageal echocardiograms. Remarkably, this case underscores the rare and significant success of conservative therapy in resolving a paravalvular abscess, a condition typically necessitating surgical intervention. This extraordinary outcome highlights the potential for non-surgical management in selected cases. The patient remains in good health upon follow-up, emphasizing the importance of multidisciplinary care and vigilant monitoring.

Keywords: Acute myocardial infarction, Infectious endocarditis, Inflammatory state, Outpatient parental antimicrobial therapy, Transesophageal echocardiography

Received: January 8, 2025; Revised: February 2, 2025; Accepted: February 2, 2025; Prepublished online: June 2, 2012; Published: September 1, 2025  Show citation