Heart transplantation for intractable prosthetic valve endocarditis.

A 25-year-old woman with active systemic lupus erythematosus and infective endocarditis was seen initially with porcine aortic bioprosthetic stenosis, perivalvar regurgitation, and native mitral regurgitation 9 years after aortic valve replacement for lupus endocarditis. Double-valve replacement was performed with St. Jude Medical mechanical prostheses. After operation the patient developed fever and an elevated white blood cell count. One month later she had increasing mitral and aortic perivalvular regurgitation and intermittent complete heart block. At reoperation both annuli showed evidence of continued infection, and she underwent annular reconstructions with pericardium and double-valve re-replacement. Cultures grew Mycoplasma hominis. Despite long-term therapy with appropriate antibiotics, within 2 months she developed recurrent perivalvar regurgitation with congestive heart failure. Orthotopic heart transplantation was performed. The postoperative course was notable for significant leukocytosis and spontaneous culture negative hemothorax that required thoracotomy for drainage. The patient recovered and is now well 14 months after operation.