Native valve endocarditis of aortic and mitral valve involving left coronary artery ostium and interventricular septum: Medical and surgical therapy

Abstract

Infective endocarditis (IE) is an infection of the inner lining of the heart muscle (endocardium) caused by bacteria, fungi, or germs that enter through the bloodstream. Despite improvements in its management, IE remains associated with high mortality and severe complications. The management of IE is multidisciplinary and is comprised of cardiologists, intensive care physicians, and cardiac surgeons. IE involving coronary ostium is very rare and sometimes such cases can cause acute coronary syndrome or sudden cardiac death. In this article, we report the case of a 48-year-old man who developed infective endocarditis involving aortal and mitral valves, as well as interventricular septum and left main coronary ostium as a result of Enterococcus faecalis. The vegetation on the ostium of the left main coronary artery has not caused coronary obstruction, but because of possible embolic events, all vegetation has been cleaned and a more appropriate repairment technique has been applied. Patient treated with vancomycin, rifampicin, and gentamicin before surgical replacement of damaged valves. We have performed aortic valve replacement, and mitral and tricuspidal valve repairment procedures. Beside of that vegetations on the interventricular septum and on the coronary ostium were extracted and damage repaired. The patient has discharged from the hospital on day 5 postoperatively without any signs of IE. Conclusion E. faecalis-associated infective endocarditis should be included in the differential diagnosis of valvular vegetation, especially in patients with a rapidly progressing clinical course. A multidisciplinary approach to IE is critical for improving the life quality of patients by reducing mortality and preventing complications. This case also highlights the importance of collecting blood cultures before initiation of antibiotic treatment.