ELDERLY PATIENT WITH A LARGE VEGETATION OF INFECTIVE ENDOCARDITIS ON THE MITRAL VALVE MANY YEARS AFTER MITRAL VALVULOPLASTY

Aim: Introduction to a case of conservative treatment of high-risk vegetation on the mitral valve in a polymorbid elderly patient. Case report: An 87-year-old patient after annuloplasty of the mitral and tricuspid valves with a ring in April 2011 was admitted for chills and shivering in July 2024. He had increased temperature, hyposaturation, and high inflammatory activity. Immediately, empiric therapy with two antibiotics was started. Transesophageal echocardiography demonstrated vegetation on the mitral valve up to 23 mm, blood cultures are repeatedly negative. A cardio center was consulted and after a comprehensive evaluation, a conservative procedure was chosen. He was treated for 6 weeks with a combination of vancomycin + meropenem. A control transthoracic echo was performed at an interval of 11 days with a clear regression of the vegetation to 4 mm. The condition was complicated by neutropenia, heart failure, development of hepatopathy and cardiorenal syndrome. After this 6-week antibiotic treatment, vegetation on the mitral valve disappears on esophageal echocardiography, laboratory signs of inflammatory activity normalize. After consultation of the antibiotic centre, he was subsequently treated with Linezolid for 2 weeks. The duration of hospitalization was exactly 3 months in the acute and then rehabilitation ward. Conclusion: It was a disease with a high risk of embolization into the arterial circulation, especially in the initial phase. The overall risk and severity of the condition is demonstrated by the development of the described complications during conservative therapy.With combined targeted antibiotic therapy, there is a relatively rapid regression of the finding of vegetation on the mitral valve. This case proves the permanent necessity of adherence to the prevention of infective endocarditis in high-risk patients.