Prosthetic Aortic Valve Infective Endocarditis Complicated With Malignant Arrhythmias: Diagnostic and Management Challenges

Prosthetic valve endocarditis (PVE) remains a serious, life-threatening complication of cardiac valve replacement, with outcomes significantly determined by timely recognition, multidisciplinary management, and appropriate surgical intervention.We report the case of a 59-year-old man with a prior mechanical aortic valve replacement, previously treated for iron deficiency anemia with recommended further workup but lost to follow-up, who presented with chest pain, hemodynamic compromise, and cardiac arrhythmias.Echocardiography confirmed severe prosthetic valve dehiscence with a paravalvular leak and peri-aortic root abscess consistent with PVE; blood cultures grew Staphylococcus epidermidis.His course was complicated by cardiogenic shock secondary to severe aortic regurgitation and bradyarrhythmias requiring emergency transvenous pacing.Despite an urgent redo aortic valve replacement with aortic root reconstruction and perioperative veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support, he subsequently developed refractory malignant arrhythmias and could not be resuscitated despite extensive efforts.This case highlights the diagnostic challenges of PVE presenting with nonspecific features, the surgical complexity of valve replacement in the setting of advanced aortic root and periannular destruction, and the catastrophic potential of postoperative malignant arrhythmias following complex infective endocarditis surgery.It underscores the critical importance of early recognition, dedicated endocarditis teams, and the need for further research into the management of postoperative arrhythmias in this high-risk population.