Early Detection of Subclinical Aortic Valve Endocarditis with the CardioMEMS Heart Failure System

Patient: Male, 79 Final Diagnosis: Infective endocarditis Symptoms: Leg edema Medication: — Clinical Procedure: — Specialty: Cardiology OBJECTIVE: Unusual clinical course BACKGROUND: The CardioMEMS Heart Failure System is a well validated tool to optimize management of systolic and diastolic heart failure and has been shown to reduce the risk of hospitalization by 37%. We are reporting a unique case of acute aortic valve insufficiency as a first sign of endocarditis, detected early in a patient with the CardioMEMS device. CASE REPORT: A 79-year-old man with dual bioprosthetic mitral and aortic valve replacement and non-ischemic cardiomyopathy had a CardioMEMS Heart Failure System implanted 2 months following valve replacement surgery. The CardioMEMS System detected a gradual but steady increase in the pulmonary artery pressures while the patient was completely asymptomatic. A transthoracic echocardiogram demonstrated evidence of severe aortic valve regurgitation and mobile vegetation. The diagnosis of infective endocarditis was made with evidence of methicillin-sensitive Staphylococcus aureus bacteremia and involvement of the bioprosthetic aortic valve. The patient ultimately underwent treatment with intravenous antibiotics and redo aortic valve replacement. CONCLUSIONS: While the CardioMEMS Heart Failure System is effective in reducing readmission rates for patients with class III heart failure, it can detect early hemodynamic changes from conditions other than congestive heart failure. Our case illustrated the CardioMEMS-assisted early diagnosis of infective endocarditis prior to clinical deterioration.