[HSF] IE

[erdinç naseri]

Would like forum's opinion ( retrospectively):
35 y/o male,4 years ago MVR,2 months ago diagnosed as S.aureus IE( 
vegetations on TEE) and treated medically and dissmissed as cured( another 
center). admitted to our center 2 weeks ago in HF and rapidly decompensated 
and intubated.TEE probe out of use ( broken), TTE showed AI+TI both severe 
Prosthhetic mitral ?,no fever no organism on blood culture ,High hepatic 
enzymes ,good renal function.Had multiple toe infartcts,splenic infarct on 
CT,2 mid size brain infarcts ( neurologists said would recover).I saw the 
patint inICU incidentally yesterday morning.Unconscious on dormicum and 
fentanyl(slight eye brow movement on painful stimuli)Cardiologist idea was 
that this was not recurrent IE but I thought that was obvious.( disscussions 
of minor and major criteria and that the patient did not fit in them).On 
evening  while leaving the hospital I observed that the patient was 
anuric.Talked to cardiologists and took the patient to OR.
OP:Quadricusp aortic valve with complete  dehiscence of the RCC, Huge 
vegetation on mitral prosthesis and severe TI.No need to cut the sutures of 
Prosthesis .Just took  the ring and with mild traction it was dehisced from 
the annulus half the way to posterior rim bilaterally.Agressive debriment of 
annulus and AVR + Re MVR+ DeVega.
Today stable hemodynamically and started opening eyes
erdinc