Early PVE

Q: 62 years old male with recent Aortic Valve Replacement (AVR) due to bicuspid Aortic Valve is readmitted due to endocarditis of the new valve. In today's world, Prosthetic Valve Endocarditis (PVE) represents the majority of all cases of endocarditis? 

A) True

B) False

Answer: B

PVE is less prevalent than as thought off with only about one-fifth of all cases of endocarditis. Aortic and mitral valve replacements equally share the frequency.

If infection occurs within eight weeks it is considered early PVE. The cause is usually direct intraoperative contamination or hematogenous spread. In the first 2 months, the valve sewing ring, cardiac annulus, and anchoring sutures have not yet become covered with endothelium, making them more susceptible to direct access to organisms. Valves are still coated with fibronectin and fibrinogen, to which organisms can adhere. Perivalvular abscesses are particularly common as the annulus is commonly the primary site of infection. It occurs with both mechanical and bio-prosthetic valves, especially in early PVE.

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References:

1. Bayer AS, Chambers HF. Prosthetic Valve Endocarditis Diagnosis and Management- New Paradigm Shift Narratives. Clin Infect Dis. 2021 May 18;72(10):1687-1692. doi: 10.1093/cid/ciab036. PMID: 33458755.

2. Ivanovic B, Trifunovic D, Matic S, Petrovic J, Sacic D, Tadic M. Prosthetic valve endocarditis - A trouble or a challenge? J Cardiol. 2019 Feb;73(2):126-133. doi: 10.1016/j.jjcc.2018.08.007. Epub 2018 Oct 30. PMID: 30389305.

3. Siciliano RF, Randi BA, Gualandro DM, Sampaio RO, Bittencourt MS, da Silva Pelaes CE, Mansur AJ, Pomerantzeff PMA, Tarasoutchi F, Strabelli TMV. Early-onset prosthetic valve endocarditis definition revisited: Prospective study and literature review. Int J Infect Dis. 2018 Feb;67:3-6. doi: 10.1016/j.ijid.2017.09.004. Epub 2017 Sep 19. PMID: 28935245.