TITLE:
Early Prosthetic Valve Endocarditis with Mycobacterium Tuberculosis after Mitral Valve Replacement: A Case Report
AUTHORS:
Papa Amath Diagne, Mory Camara, Papa Ousmane Ba, Momar Sokhna Diop, Moussa Samba, Abdou Lahad Mbengue, Jean Claude Ndiogou Dione, Myriam Bizrane, Marième Soda Mbaye, Moussa Seck Diop, Toudiani Malam Kaka, Papa Salmane Ba, Papa Adama Dieng, Amadou Gabriel Ciss, Assane Ndiaye
KEYWORDS:
Tuberculous Endocarditis, Prosthetic Valve Endocarditis, Mycobacterium Tuberculosis
JOURNAL NAME:
World Journal of Cardiovascular Surgery,
Vol.14 No.3,
March
25,
2024
ABSTRACT: Background: Tuberculous endocarditis is a rare but serious complication of heart
valve replacement surgery. We report the case of a 24-year-old patient, who
presented with tuberculous endocarditis after mechanical mitral valve
replacement, with a favorable clinical course following anti-tuberculosis
treatment. Case Presentation: We report a 24-year-old male patient,
admitted to the cardiac surgery department of the Fann Hospital (Dakar,
Senegal), for the management of severe mixed (rheumatic and endocarditic)
mitral insufficiency with associated tricuspid insufficiency. He had a history
of recurrent angina and polyarthralgia in childhood, was hospitalized several
times for refractory global cardiac decompensation, and for a suspected
infective endocarditis a month before his admission. On admission, the clinical
examination revealed signs suggestive of mitral and tricuspid insufficiency.
Transthoracic echocardiography revealed severe post-endocarditic mitral
insufficiency with A3 amputation, highly mobile 15 mm vegetations on the free
edge of the large valve, moderate tricuspid insufficiency, and severe pulmonary
artery hypertension. Mechanical mitral valve replacement and tricuspid valve
annuloplasty using autologous pericardial strip were performed via median
sternotomy. After ten days, the patient presented with global cardiac
decompensation associated with a clinico-biological infectious syndrome, and
tans-oesophageal echography revealed an abscess at the sinotubular junction,
communicating with the aorta. A thoraco-abdomino-pelvic CT scan was done, which
revealed a bilateral alveolar-interstitial syndrome with mediastinal
lymphadenopathy. Anti-tuberculosis treatment with RHZE was initiated for 06
months. The clinical course was favorable. Conclusion: Tuberculous endocarditis
in prostheses is a serious complication of heart valve replacement surgery,
which may evolve favorably under medical treatment.