Infected Thrombus on a TAVI Aortic Valve

J INVASIVE CARDIOL 2020;32(5):E138.

Key words: cardiac imaging, conduction block, endocarditis, TAVI, thrombus 

An 86-year-old man with a history of transcutaneous aortic valve implantation (TAVI) 2 years prior to his admission was admitted to our hospital due to weakness and low-grade fever for 1 week. The patient was known to have a higher than normal pressure gradient post TAVI and received anticoagulation for the last year due to suspected post-TAVI valve thrombosis. Two months prior to his admission, the patient was diagnosed at another medical center with bacterial endocarditis of his prosthetic aortic valve, after blood cultures were positive for Enterococcus faecalis. The patient was treated for 4 weeks with daptomycin and was considered disease free. Upon admission to our center, the patient exhibited a third-degree (complete) atrioventricular block on electrocardiogram. The patient was hemodynamically stable and did not require transcutaneous pacing or inotropic support. Echocardiography showed high pressure gradients (100 mm Hg) on the aortic valve, and suspected thrombus or vegetation on the aortic valve. A computed tomography scan with intravenous contrast was performed, showing a large filling defect on the prosthetic aortic valve (Figure 1). Blood cultures drawn at the patient’s admission returned positive for the same Enterococcus faecalis grown at the prior admission. The patient was suspected to have an infected thrombus on a TAVI valve and was referred to urgent surgery. The valve with the infected thrombus (Figure 2) was removed and a biological prosthetic valve was implanted in its place. The procedure and its postprocedural course were uneventful.

From the ¹Department of Cardiology; ²Department of Cardiothoracic Surgery; ³Cardiac Imaging Service; and ⁴Internal Medicine J, Tel Aviv Medical Center, Tel Aviv, Israel.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein. 

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted August 14, 2019.

Address for correspondence: Ilan Merdler, MD, MHA, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 6423906, Israel. Email: ilanmerdler@gmail.com