Reoperation for multivalvular prosthetic valve infective endocarditis: successful urgent surgical management of severe mitral and aortic insufficiency: a case report
Year: 2026
Type: article
Study design: Case Report
Abstract: Background: Infective endocarditis (IE) remains a life-threatening condition with in-hospital mortality of 15–30%, rising substantially in multivalvular disease. Prosthetic valve endocarditis (PVE) following cardiac surgery carries additional operative risk due to the requirement for complete prosthetic debridement. We report a case of multivalvular PVE with large mobile mitral vegetations, Staphylococcus aureus bacteraemia, and multifocal systemic embolisation requiring urgent reoperation. Case presentation: A 69-year-old male with prior mitral annuloplasty presented with progressive heart failure, recurrent fever, and embolic cerebral and splenic infarcts. Echocardiography demonstrated large mobile mitral vegetations with severe mitral regurgitation (MR grade III–IV) and significant aortic regurgitation (AR grade III–IV). Blood cultures yielded Staphylococcus aureus. The diagnosis of definite IE was confirmed by 2023 ESC Duke-modified criteria. Urgent reoperation was performed: complete excision of the infected annuloplasty ring, radical debridement of all vegetations, and biological double-valve replacement. Cardiopulmonary bypass time was 185 minutes; cross-clamp time 135 minutes. Four weeks of targeted vancomycin therapy were administered postoperatively. The patient was discharged in stable condition with normalised inflammatory markers and satisfactory prosthetic function on echocardiography. Conclusion: Multivalvular PVE requires prompt echocardiographic diagnosis, urgent surgical intervention with complete prosthetic debridement, and extended targeted antimicrobial therapy. A multidisciplinary Endocarditis Team approach is essential for optimal outcomes in this high-risk population. Keywords: infective endocarditis; prosthetic valve endocarditis; multivalvular endocarditis; Staphylococcus aureus; double-valve replacement; reoperation; cardiac surgery; Duke criteria; case report
Source: Georgian Medical Journal
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7204116870