Multivalvular infective endocarditis

Case report

Abstract

Infective endocarditis (IE) is a disease that mainly affects the heart valves and is associated with high morbidity and mortality. Multivalvular involvement is rare, with an incidence of 12 to 30%. Identification of the causative microorganism and imaging studies are crucial for diagnosis and follow-up. We present the case of a 32-year-old male patient with a diagnosis of multivalvular
endocarditis caused by viridans streptococci with an odontogenic focus. The initial transesophageal echocardiogram (TEE) reported a bicuspid aortic valve with the presence of two adherent vegetations and a rupture of the posterior leaflet, causing severe valve regurgitation that
required emergency surgery for aortic valve replacement. The follow-up transthoracic echocardiogram (TTE) at 48 hours revealed multiple vegetations not identified in the previous study with perforation of the anterior leaflet of the mitral valve and moderate mitral valve regurgitation.
Given the rapid onset and progression of mitral valve damage, a reintervention for the placement of a mechanical mitral prosthesis was required. An adequate clinical response was obtained after management with antibiotic therapy and he was discharged without complications.