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A3454 - Infective Endocarditis Occurring After Mitral Clip Procedure; A Unique Complication of a Unique Procedure
Author Block: E. Charbek1, M. Reddy2, N. Malhotra3, Z. Jamkhana4; 1Pulmonary critical care medicine, saint louis university, St. Louis, MO, United States, 2Saint Louis University, St. Louis, MO, United States, 3Internal Medicine, saint louis university, st louis, MO, United States, 4pulmonary critical care medicine, saint louis university, st louis, MO, United States.
Introduction: Transcatheter mitral valve repair using the MitraClip system or simply, MitraClip procedure, is a therapeutic option in high-risk surgical or inoperable patients. We report a case of infective endocarditis in a patient with MitraClip prosthesis.
Case Discussion: A 36-year-old male with Human Immunodeficiency Virus (HIV), end-stage renal disease secondary to HIV nephropathy, non-ischemic cardiomyopathy, and severe mitral regurgitation status post uncomplicated MitraClip procedure four months prior, presented from an outpatient dialysis center with generalized fatigue, dyspnea on exertion, fever and chills of 2 days duration. The patient reported dry cough with no chest pain or hemoptysis. The patient endorsed adherence to his antiretroviral therapy. On physical examination, he was febrile and had a tunneled right internal jugular dialysis catheter that was not tender or erythematous. CT angiogram of the chest showed left upper lobe segmental pulmonary emboli and a right lower lobe consolidation. Blood cultures were positive for Methicillin Resistant Staphylococcus Aureus (MRSA). Vancomycin and Cefepime were started empirically for presumed diagnosis of infective endocarditis. Transesophageal echocardiogram showed a vegetation overlying the MitraClip consistent with mitral valve endocarditis as well as a superior vena cava thrombus at the tip of the right internal jugular tunneled catheter. The patient was started on a heparin drip and the tunneled catheter was removed. He later became hypotensive and was transferred to the ICU for septic shock. Subsequent CT with IV contrast showed septic emboli in the lungs, liver and spleen. He remained bacteremic despite antibiotics. Unfortunately, the patient became hypoxic, bradycardic and suffered PEA arrest without ROSC.
Discussion: Mitral valve regurgitation is a common heart valve disorder with a prevalence of 1-2% in the general population. Surgical mitral valve repair is considered the standard of care in moderate to severe mitral regurgitation. In patients that are of high surgical risk, the MitraClip procedure can be performed as an alternative. It is necessary to ascertain individualized risk and comorbidity before performing the procedure. Infective endocarditis is rarely seen after MitraClip procedure and to our knowledge only 6 prior cases of infective endocarditis following MItraClip have been published. The incidence of this complication will likely increase as this procedure becomes more widely adopted. The clinician must keep infective endocarditis as a potential complication in mind as early recognition and treatment is key in managing infective endocarditis in general and especially in the immunocompromised patient with prostheses and foreign bodies.