Congenital substrate and multivalvular destruction by Enterococcus Faecalis. Endocarditis spectrum and use of Micra in active infection.

Abstract

Introduction: Untreated infective endocarditis has a mortality close to 20%. Its incidence has increased in recent years. Congenital heart diseases in adults, whose incidence is growing constantly, constitute a permanent risk factor for infective endocarditis.  The epidemiology of the causative microorganisms in congenital heart diseases does not differ from that of acquired endocarditis.  Right, endocarditis is more common in this group.

Clinical case: 58-year-old woman with high blood pressure and restrictive perimembranous ventricular septal defect. He has a 1-month history of fever associated with the extraction of 2 molars. She was treated with oral Antibiotic therapy in the first instance and then intravenously. During hospitalization, Enterococcus Faecalis is isolated in a blood culture. In the last 24 hours, dyspnea on slight exertion is associated with a holo diastolic murmur at the aortic level and a systolic murmur at the tricuspid level. With signs of pulmonary congestion, initial screening with echocardiogram was performed, showing severe aortic insufficiency and torrential tricuspid with the presence of vegetations at the aortic and tricuspid level (>10 mm), so TEE was performed, showing periaortic abscess (17x9 mm) requiring intervention. Emergent surgery with double aortic and tricuspid valve replacement with bioprosthesis, intraoperatively intercurrent with block complete atrioventricular that lasted for 72 hours, for which a Micra pacemaker was placed with favorable evolution.

Conclusions: The transcatheter implantation of the Micra Pacemaker (wireless system) is an effective option in patients with infective endocarditis who have required urgent valve replacement and have presented conduction disorders with infection still active in the blood. Antibiotic prophylaxis is recommended for patients with congenital substrate who undergo high-risk dental procedures. Given the impact of infection related to implantable electronic devices on morbidity, mortality, and cost, these findings have significant clinical importance.