PMC8774295_01
Initial transesophageal echocardiography in recurrent fever and persisting bacteremia. Transesophageal echocardiography at day 26 following mitral valve edge-to-edge repair. Right: Zoom on mitral valve. White arrows indicate an echogenic structure suspicious for vegetation (Day 26: Supplementary Videos 1, 2).
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F1
TOE interpretation excluded IE, while a small echogenic structure on the PASCAL Ace device was suspicious for vegetation (Figure 1; Supplementary Videos 1, 2). The antibiotics were discontinued, but the patient suffered from decompensated heart failure with peripheral edema and pleural effusion as consequence of the sepsis infusion therapy.
Progress of infective endocarditis in transesophageal echocardiography. Transesophageal echocardiography of infective endocarditis at various timepoints during calculated antibiotic therapy. Day 0 = transcatheter mitral valve edge-to-edge repair. White arrows indicate vegetations. Yellow arrows show perforated posterior mitral leaflet and significantly reduced vegetation (Day 36: Supplementary Videos 3, 4; Day 43: Supplementary Videos 5, 6; Day 50: Supplementary Videos 7, 8; Day 57: Supplementary Videos 9, 10).
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PASCAL Ace device was confirmed by a vegetation accompanied by a mild to moderate mitral regurgitation (Figure 2, Day 36; Supplementary Videos 3, 4). Patient was transferred to the Cardiology ward and the local endocarditis team (infectious disease specialist, cardiologist, microbiologist and radiologist) contacted the cardiac surgeon to discuss explantation of the PASCAL Ace device. Weekly TOEs were performed (Figure 2; Day 43: Supplementary Videos 5, 6; Day 50: Supplementary Videos 7, 8; Day 57: Supplementary Videos 9, 10).
C-reactive protein and leucocytes over the clinical course of infective endocarditis. TEER, transcatheter edge-to-edge repair; TOE, transesophageal echocardiography; IE, infective endocarditis; MVR, mitral valve repair; Pip/Taz, piperacillin/tazobactam; Amp/Sulb, ampicillin/sulbactam; tds, three times a day; qds, four times a day; td, twice daily; CRP, C-reactive protein.
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Figure 3 shows the inflammatory markers over the clinical course starting at the timepoint of TEER (day 0).
Intraoperative views of PASCAL Ace infective endocarditis. Intraoperative pictures during endoscopic mitral valve repair in infective endocarditis of a PASCAL ACE device.
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On day 69 the patient underwent successful endoscopic mitral valve replacement with a bioprothesis (St Jude Medical Epic 33 mm, Abbott Vascular, Santa Clara, CA, USA; Figure 4).