USE OF TANDEM HEART FOR CARDIOGENIC SHOCK AND SEVERE AORTIC INSUFFICIENCY IN BARTONELLA HENSELAE INFECTIVE ENDOCARDITIS

Document Type

Conference Proceeding

Publication Date

4-1-2024

Publication Title

J Am Coll Cardiol

Abstract

Background Bartonella species infection, especially Bartonella henselae, is an increasingly common cause of culture-negative Infective Endocarditis (IE), which carries an exceedingly high morbidity and mortality. The necessity of valvular intervention for these cases has been found to be higher than on culture positive IE. Case A 53-year-old Hispanic man with no past medical history presented to the with palpitations, exertional dyspnea, orthopnea, and a non-intentional thirty-pound weight loss. His social history was significant for cohabitating with 20 domestic cats. Initial workup revealed leukocytosis, azotemia and transaminitis. Microbiologic studies showed negative blood cultures. Chest radiograph showed signs of bilateral pulmonary edema. Transthoracic echocardiogram showed preserved ejection fraction, no diastolic dysfunction and signs of bicuspid aortic valve with severe aortic insufficiency (AI). Transesophageal echocardiogram confirmed the previous findings and revealed vegetations on the aortic valve. Blood gases revealed severely low cardiac indices. Due to his rapid clinical deterioration, he was admitted to the Cardiac Intensive Care Unit and started on vasopressors and inotropic agents. Infectious Diseases and Cardiac Surgery were consulted. Decision-making Upon further workup for culture-negative IE, Bartonella antibody titers were found positive. Cardiac Surgery recommended no surgical intervention due to the patient being to hemodynamically unstable and high risk. Despite maximizing inotropic agents and preload management, his course was complicated by SCAI Stage D cardiogenic shock and multiorgan system failure. Due to the severe AI, intraaortic balloon pump was contraindicated; and due to risk of septic embolism, devices such an Impella were contraindicated. Ultimately, a percutaneous Tandem Heart left ventricular assist device was placed and helped to successfully stabilize the patient. Conclusion IE can have several complications such as severe valvular disease leading to refractory cardiogenic shock. The usefulness of MCS in these patients is extremely high as a transient step until a definite valvular intervention.

Volume

83

Issue

13

First Page

3177

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