Infective endocarditis after transcatheter aortic valve implantation with LOTUS valve

Prosthetic valve endocarditis (PVE) after transcatheter aortic valve implantation (TAVI) is a serious complication, but limited number of cases has been reported. An 84-year-old man who had performed TAVI with a 25 mm LOTUS valve (Boston Scientific, Natick, Massachusetts) for severe aortic stenosis was readmitted to our institution at 1 year after TAVI due to PVE without symptoms of heart failure. He had a history of pacemaker implantation, atrial fibrillation, lung sarcoidosis, and bronchial asthma. His body temperature was high (38.1 °C), the white blood cell count was 14 200 mg/L and the C reactive protein level was elevated (5.1 mg/dL). All of six blood cultures were positive for Streptococcus gordonii. The transoesophageal echocardiography revealed a large structure (10*9 mm) on the TAVI valve (Panel A; white arrow) that was diagnosed of vegetation. The patient was taken for antibiotic therapy with gentamycin, vancomycin, and rifampicin. Our heart team made the decision for urgent surgery because the vegetation was larger than 10 mm and an embolization to the popliteal artery had occurred. Cardiopulmonary bypass was established in a standard fashion. Vegetation was observed on the ventricular side of TAVI valve leaflet (Panel B; aorta side, Panel C; ventricular side) and resected. A 23-mm Edwards bioprosthetic valve was reimplanted. The same bacterium was detected from TAVI valve. The intraoperative and postoperative courses were uneventful. This case highlights that vegetation on the ventricular side of AV was clearly detected after open AV surgery indicated as part of treatment for PVE after TAVI.