Recurrent Endocarditis in Silver-Coated Heart Valve Prosthesis

J Heart Valve Dis. 1999 Mar;8(2):140-2.

Abstract

Background and aim of the study: In order to prevent prosthetic valve endocarditis (PVE), the implantation of a new silver-coated sewing ring has been introduced to provide peri- and postoperative protection against microbial infection.

Methods: A 56-year-old woman with aortic stenosis had elective replacement with a St. Jude Medical mechanical valve fitted with a silver-coated sewing ring (Silzone). The patient developed early PVE, which necessitated reoperation after one month. Despite a second Silzone prosthesis being implanted, the endocarditis recurred. During a third operation an aortic homograft was implanted, and after six months a fourth operation was performed for a pseudoaneurysm at the base of the homograft, in proximity to the anterior mitral valve leaflet.

Results: The diagnosis of PVE was confirmed by the presence of continuous fever, transesophageal echocardiography and growth of penicillin-resistant Staphylococcus epidermidis from the valve prosthesis.

Conclusion: The implantation of all prosthetic valves is encumbered with a risk of endocarditis. Although silver has bacteriostatic actions, the advantages of silver-coated prostheses in the treatment of this condition have yet to be assessed in clinical trials.

Publication types

  • Case Reports

MeSH terms

  • Anti-Bacterial Agents
  • Aortic Valve Stenosis / surgery
  • Coated Materials, Biocompatible / adverse effects*
  • Drug Therapy, Combination / therapeutic use
  • Echocardiography, Transesophageal
  • Endocarditis, Bacterial / diagnostic imaging
  • Endocarditis, Bacterial / etiology*
  • Endocarditis, Bacterial / therapy
  • Female
  • Follow-Up Studies
  • Heart Valve Prosthesis / adverse effects*
  • Heart Valve Prosthesis Implantation
  • Humans
  • Middle Aged
  • Prosthesis-Related Infections / diagnostic imaging
  • Prosthesis-Related Infections / etiology*
  • Prosthesis-Related Infections / therapy
  • Recurrence
  • Reoperation
  • Silver
  • Staphylococcal Infections / diagnostic imaging
  • Staphylococcal Infections / etiology*
  • Staphylococcal Infections / therapy
  • Staphylococcus epidermidis / isolation & purification

Substances

  • Anti-Bacterial Agents
  • Coated Materials, Biocompatible
  • Silver