Non-ST-Segment Elevation Acute Coronary Syndrome From Transcatheter Aortic Valve Replacement Infective Endocarditis Embolization.

BACKGROUND: Transcatheter aortic valve replacement (TAVR) is a widely established treatment for severe aortic stenosis. Infective endocarditis (IE) following TAVR is an uncommon but significant complication occurring in 1% of patients. CASE SUMMARY: A 70-year-old man with a prior TAVR presenting with chest discomfort and elevated troponins was diagnosed with non-ST-segment elevation-acute coronary syndrome. Coronary angiography demonstrated an occluded LAD; aspiration thrombectomy yielded material consistent with vegetation. Blood cultures resulted with Enterococcus faecalis. Transesophageal echocardiogram showed vegetations on the bioprosthesis consistent with IE. The patient was treated with medical therapy, and subsequent echocardiograms demonstrated resolution of the vegetations with intravenous antibiotics. DISCUSSION: IE is associated with a high incidence of complications and poor prognosis. Given the continued rise of TAVR as a treatment strategy, clinicians should have a detailed understanding of this disease process. TAKE-HOME MESSAGE: IE is an uncommon, life-threatening complication after TAVR. These patients can present atypically, warranting a heightened index of suspicion.