Paravalvular Abscess of the Mechanical Prosthetic Aortic Valve: A Case Report

BACKGROUND: Prosthetic mechanical valve endocarditis (PVE) can be manifested as early PVE (acquired perioperatively) and late PVE (resulting from infections unrelated to the valve operation). Causes of both are similar but are late PVE are more prone to less virulent microbes. PVE resulting with paravalvular abscess is confirmed through echocardiography (transthoracic or transesophageal), it results with a high mortality rate especially if it is not early recognized. The aim of article was to present a patient with heart failure symptoms caused by PVE. CASE PRESENTATION: Male patient, 44 years old, was admitted because of dyspnea and swelling of lower extremities. The patient is a long-standing heroin addict who had aortic valve replacement done 8 years ago due to endocarditis. The implanted valve was a mechanical aortic valve – Edwards MIRA bi-leaflet valve No 32 (Edwards Lifesciences; Irvine, California). He also was already diagnosed with hepatitis C years before. In multiple occasions were hospitalized on the Department of cardiology due to signs and symptoms of heart failure. On transthoracic echocardiography, dilatation of all heart chambers was found. The left ventricular systolic function was moderately reduced with an ejection fraction of left ventricle of 42% according to Simpson with restrictive filling pattern. Hypoechoic mass along the right side of the mechanical aortic valve was noted measuring 3.57 × 1.03 cm. CONCLUSION: Paravalvular abscess of mechanical heart valves is a very serious complication with a high mortality rate. It is essential to recognize this type of pathology as early as possible, so aggressive parenteral antibiotic therapy could be started, while in many cases, surgical reoperation is needed.