BMJ Case Reports 2018; doi:10.1136/bcr-2018-225037
  • Reminder of important clinical lesson

Early prosthetic valve endocarditis after transcatheter aortic valve implantation using St Jude Medical Portico valve

  1. Samer Arnous2
  1. 1 University of Limerick Graduate Entry Medical School, Limerick, Ireland
  2. 2 Cardiology Department, University of Limerick Hospitals Group, Limerick, Ireland
  1. Correspondence to Dr Abdalla Ibrahim, abdalla.ibrahimmd{at}
  • Accepted 2 May 2018
  • Published 14 May 2018


An 87-year-old woman presented to the emergency department with a 2-week history of progressively worsening shortness of breath, fever and generalised myalgia. She underwent a transcatheter Portico aortic valve implantation for severe symptomatic aortic stenosis 3 months prior to this presentation. Examination revealed a temperature of 40°C and a systolic murmur in the aortic area. Inflammatory markers were elevated, and blood cultures were positive for methicillin-sensitive Staphylococcus aureus. A possible diagnosis of infective endocarditis was made as one major and one minor criterion in the modified Duke criteria were fulfilled. Subsequent transoesophageal echocardiography (TOE) demonstrated vegetation attached to the prosthetic valve stent frame at the level of the left ventricular outflow tract. She was started on a prolonged course of intravenous antibiotics, and follow-up TOE, 4 weeks later, confirmed resolution of the vegetation. She was discharged home after prolonged hospital stay.


  • Contributors All authors contributed equally to the preparation of this manuscript. AI conducted the design of the work and collected the data. AA arranged the videos and drafted the manuscript. TK conducted critical revision of the manuscript. SA edited and approved the final version to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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