Periannular extension of infective endocarditis with atrioventricular block successfully treated with antibiotic therapy after transcatheter aortic valve implantation: a case report.

Background: Although transcatheter aortic valve implantation (TAVI) is performed for very elderly patients in whom surgical aortic valve replacement (SAVR) poses unacceptably high operative risk, some of these patients are ultimately forced to undergo open surgery when TAVI is complicated by infective endocarditis (IE). To our knowledge, there have been no reports of cases with periannular extension of IE and atrioventricular block successfully treated by antibiotics without valve replacement.

Case summary: An 80-year-old Japanese man who had undergone TAVI developed IE with loss of consciousness on Day 39 after the procedure. Methicillin-resistant Staphylococcus aureus was detected in his blood culture. Electrocardiography (ECG) showed complete atrioventricular block. Transoesophageal echocardiography (TEE) detected vegetation on the anterior mitral leaflet, aorta, and common annulus. Transcatheter aortic valve implantation had been performed rather than SAVR to avoid the associated operative risks. Because his haemodynamic condition was stable, we decided upon antibiotic treatment alone. On Day 42 after admission, TEE showed a reduction in the size of the vegetation, and his ECG recovered to sinus rhythm.

Discussion: Medical treatment alone was effective for a periannular extension of IE complicated with complete atrioventricular block in a very elderly patient after TAVI had been performed to avoid high operative risk.