80. Case Report: Prosthetic Valve Endocarditis with Aortic Regurgitation Brigham and Womens Hospital
CardioNerds (Amit Goyal & Daniel Ambinder) join Brigham and Women\u2019s Hospital cardiology fellows (Mounica Yanamandala, Simin Lee and Maria Pabon Porras) for some fun times at the Charles River Esplanade! They discuss a complicated case of prosthetic valve endocarditis with aortic regurgitation. Dr. Dale Adler provides the E-CPR and program director Dr. Donna Polk provides a message for applicants. Episode notes were developed by Johns Hopkins internal medicine resident Bibin Varghese with mentorship from University of Maryland cardiology fellow Karan Desai. \n\n\n\n\n\nJump to: Patient summary - Case media - Case teaching - References \n\n\n\nEpisode graphic by Dr. Carine Hamo\n\n\n\n\n\n\n\nThe\xa0CardioNerds Cardiology Case Reports\xa0series shines light on the hidden curriculum of medical storytelling. We learn together while discussing fascinating cases in this fun, engaging, and educational format. Each episode ends with an\xa0\u201cExpert CardioNerd Perspectives & Review\u201d (E-CPR)\xa0for a nuanced teaching from a content expert. We truly believe that hearing about a patient is the singular theme that unifies everyone at every level, from the student to the professor emeritus.\n\n\n\nWe are teaming up with the\xa0ACC FIT Section\xa0to use the\xa0#CNCR episodes\xa0to showcase CV education across the country in the era of virtual recruitment. As part of the recruitment series, each episode features fellows from a given program discussing and teaching about an interesting case as well as sharing what makes their hearts flutter about their fellowship training. The case discussion is followed by both an\xa0E-CPR\xa0segment and a message from the program director.\n\n\n\nCardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademySubscribe to our newsletter- The HeartbeatSupport our educational mission by becoming a Patron!Cardiology Programs Twitter Group created by Dr. Nosheen Reza\n\n\n\n\n\n\n\n\n\n\n\nPatient Summary\n\n\n\nA male in his mid-40s with history of HIV on ART\xa0(undetectable VL,\xa0CD4\xa0320)\xa0and idiopathic thoracic ascending aortic aneurysm (TAAA) with AR s/p bioprosthetic valve replacement 10 years prior presented with acute onset lightheadedness and pre-syncope. He was diagnosed with an idiopathic\xa0TAAA\xa0at age 30 after he was noted to have an incidental murmur.\xa0Over the next few years, his aortic root increased to over 7 cm with severe AR, LV dilation, and\xa0reduced LVEF of 45%. He underwent bioprosthetic\xa0aortic\xa0valve replacement\xa0and root repair\xa0with a Medtronic freestyle\xa0porcine aortic root\xa0with subsequent\xa0recovery of his\xa0 LVEF to 50% and improved LV dilation. Thereafter, he was doing well until he reported a flu like illness 3 weeks prior to presentation with reported fever up to 101.3 F and associated myalgias. He denied any sick contacts or recent travel and was adherent to his HIV regiment. On the day of presentation, he was walking his dogs when he developed acute onset lightheadedness\xa0with\xa0presyncope.\xa0On presentation, he had a low grade fever, tachycardia,\xa0tachypnea, and hypoxia.\xa0On exam, cardiac exam was notable for loud blowing diastolic murmur, non-distended JVP,\xa0decreased breath sounds,\xa0warm extremities with bounding pulses\xa0and without edema.\xa0There were no stigmata of endocarditis.\xa0Labs revealed elevated cardiac and inflammatory biomarkers.\xa0Blood cultures were initially NGTD. CXR\xa0corroborated the exam with\xa0bilateral interstitial and airspace opacification with effusions. TTE showed LVEF 35%\xa0with\xa0global hypokinesis,\xa0dilated LV with\xa0LVEDD 7.5 cm,\xa0mild\xa0RV\xa0systolic dysfunction, severe AR with holo-diastolic flow reversal in the abdominal aorta, no prosthetic stenosis, and aortic root 31 mm. TEE\xa0showed a well-seated\xa0AVR with leaflet thickening and several echodensities.\xa0CT surgery deemed patient to be high risk for the OR. After a few days, patient required intubation for increased work of breathing and acute decompensation requiring\xa0vasoactive infusions.\xa0After multidisciplinary discussions, the patient ultimately underwent ViV TAVR\xa0with successful placement of a 29 mm\xa0E...