Post-Transcatheter Aortic Valve Replacement Infective Endocarditis Leading to Mitral Anterior Leaflet Perforation: A Case Report

Transcatheter aortic valve replacement(TAVR)-related infective endocarditis is a rare but fatal complication that can lead to mitral valve perforation. The clinical presentation usually includes rapidly progressive heart failure and mitral regurgitation. Transesophageal echocardiogram (TEE) is considered superior to transthoracic echocardiogram (TTE) in delineating the diagnosis of mitral valve perforation. We present a case of a 75-year-old female who had a TAVR for severe aortic stenosis three years ago and presented with new-onset atrial fibrillation and developed rapidly progressive acute decompensated heart failure. A TTE showed echogenic vegetation of the mitral valve with a perforated mitral anterior leaflet and mitral regurgitation. The blood cultures grew Group B Streptococcus, and our patient lacked the risk factors for infective endocarditis, including alcoholism, chronic liver disease, pregnancy, immunosuppression, or malignancy. This article highlights infective endocarditis with an uncommon pathogen in a patient with a prior TAVR that leads to the fatal complication of mitral valve perforation.