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

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.