What is the clinical evidence from this study?

Study design: Case Report. Population: Prosthetic valve endocarditis (n=1). Intervention: Aortic root replacement and coronary artery bypass grafting. Primary outcome: Clinical outcome.

What does this research mean for the field?

Early prosthetic valve endocarditis can manifest as acute right coronary artery occlusion from septic embolization, which coronary imaging alone may fail to distinguish from acute thrombus. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To describe a rare case of early prosthetic valve endocarditis presenting as acute coronary syndrome secondary to septic embolization one month after surgical aortic valve replacement.

May 9, 2026General Thoracic and Cardiovascular Surgery CasesOpen Access

Early prosthetic valve endocarditis presenting as acute right coronary artery occlusion 1 month after aortic valve replacement: a case report

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Key result

Emergent surgery for prosthetic valve endocarditis presenting as acute RCA occlusion precedes fatal mesenteric ischemia.

Why the study?

Prosthetic valve endocarditis is challenging to diagnose in the early postoperative period, and its presentation as acute coronary syndrome from coronary embolization is exceptionally uncommon.

Key Points

To describe a rare case of early prosthetic valve endocarditis presenting as acute coronary syndrome secondary to septic embolization one month after surgical aortic valve replacement.
A 73-year-old male presenting with cardiogenic shock and right coronary artery occlusion one month after aortic valve replacement with a 21-mm bioprosthesis was evaluated.
Diagnostic and interventional assessments included emergent coronary angiography, intravascular ultrasound, contrast-enhanced CT, echocardiography, and emergent redo cardiac surgery.
Intravascular ultrasound and contrast-enhanced CT initially misidentified an infected ostial vegetation as thrombotic material during acute right coronary artery revascularization.
Subsequent echocardiography identified prosthetic valve dehiscence and an annular abscess, necessitating aortic root replacement, coronary artery bypass grafting, and veno-arterial ECMO support.
The patient developed profound circulatory failure and died from non-occlusive mesenteric ischemia on postoperative day 10.

Study Design

Type

Case Report (n=1)

Multicenter

Structured PICO

Population

A 73-year-old man who underwent surgical aortic valve replacement with a 21-mm bioprosthetic valve 1 month prior

Intervention

Emergent surgery including annular reconstruction with a bovine pericardial patch, aortic root replacement, removal of the coronary stent, and coronary artery bypass grafting (following initial percutaneous coronary intervention)

Outcome

Clinical course and mortality

Early prosthetic valve endocarditis can rarely present as acute coronary syndrome due to coronary embolization, highlighting the need for early valve-focused echocardiography in patients with recent valve surgery presenting with acute coronary events.

Limitations

Histological confirmation of the embolus was not available

Discussion

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Implication

Acute RCA occlusion from early PVE can prove fatal despite surgery; leaves open role of valve-focused echocardiography in post-valve ACS.

Cite This Study

Yokawa et al. (2026) conducted a case report in Prosthetic valve endocarditis (n=1). Aortic root replacement and coronary artery bypass grafting was evaluated on Clinical outcome. A 73-year-old man with early prosthetic valve endocarditis presenting as acute right coronary artery occlusion underwent emergent surgery but died from non-occlusive mesenteric ischemia on postoperative day 10.

synapsesocial.com/papers/69fed153b9154b0b8287893a https://doi.org/10.1186/s44215-026-00257-2

Topics

Infective endocarditis Chronic total occlusion PCI

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Early prosthetic valve endocarditis presenting as acute right coronary artery occlusion 1 month after aortic valve replacement: a case report

Key Points

Study Design

Structured PICO

Limitations

Discussion

Implication

Cite This Study

Topics

Early prosthetic valve endocarditis presenting as acute right coronary artery occlusion 1 month after aortic valve replacement: a case report

Key Points

Study Design

Structured PICO

Limitations

Discussion

Implication

Cite This Study

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