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Date of last update: 10/20/2017.

Forum Name: Valvular Heart Diseases

Question: Ankylosing spondylitis and aortic valve replacement

 andrea - Sun Feb 02, 2003 3:47 pm

My brother needed AVR when he was 17 due to ankylosing spondylitis, he recovered fine from the operation, but last week (5 years on) he died suddenly due to cardiogenic shockthe reason we were given was that he had developed bacterial endocarditis. I wanted to know how he could have picked this up? and also why would it not have been detected, as he had many check-ups?
I hope you can help me with my questions.
 Dr. Yasser Mokhtar - Mon Feb 03, 2003 2:25 pm

User avatar Dear Andrea,

Thank you very much for using our website.

My sympathies and condolensces about your brother.

Bacterial endocarditis means infection of a heart valve. It is not something that is picked up along the years and can be detected by regular check-ups. It is something that happens acutely like any other infection. Infection of a heart valve usually has a bad prognosis and in most of the cases the prognosis is worse if the patient has an artificial valve because it is usually more difficult to treat infected artificial heart valves.

The case presentation could be very acute like with your brother and could take few days to few weeks even.

It is usually treated with hospitalization and big doses of continuous iv antibiotics for a long time. If the patient does not respond, espeically if there is an artificial valve and if his medical condition allows according to what his doctor thinks, change of the valve and putting a new one in is the treatment of choice (if patient can to go through such a surgery).

i do not know about your brother's condition and the word "suddenly" means different things to different people on time frame basis so if you could elaborate more on what you mean by "suddenly" would be helpful to me to try to interpret your brother's case.

Cardiogenic shock means simply that the patient's heart was very weak because the infected valve was not working the way it is supposed to because it was infected.

Once more, thank you very much for using our website and i hope that this information helped and if you still have any more concerns or questions do not hesistate to post them.

Yasser Mokhtar, M.D.
 Anonymous - Fri Feb 07, 2003 6:23 am

Thank you for your reply.

By suddenly I meant in one day. My brother felt unwell one morning ( i think also the night before as well) and he went to the doctor that night who advised him to go to the hospital for a chest x-ray. When he was in the hospital the doctors thought they heard a murmer in his heart and told him to stay in overnight so they could do more tests. During the early hours of the next morning(01.30) he started wheezing and then became worse and after struggling for 3 or 4 minutes he died.

How could the infection have been picked up?
 Dr. Yasser Mokhtar - Sun Feb 09, 2003 8:49 pm

User avatar Dear Andrea,

Thank you very much for using our website.

The picture that you described sound to me like an acute event which could be caused by:
1. Acute heart failure: that can be caused by:
a. Massive heart attack.
b. Severe infection of the mechanical valve and its sudden dysfunction.
c. Severe infevtion of a natural valve even.
d. Sudden clotting of the mechanical valve.

2. Big blood clot to the lungs.
3. Severe asthmatic attack.
4. Sudden dissection of the aorta.
5. Fluid around the heart.
6. Sudden air around the lungs.

i say all that not knowin anything about your brother except that he had an artificial valve and ankylosing spondylitis.

The best way to really find out what happen to your brother is to perform an autopsy. i know it is a very difficult decision to make, but if you are too worried and want to find out exactly what happened then this is the way to go.

Once more, thank you very much for using our website and i hope that this information helped.

Yasser Mokhtar, M.D.

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