ABSTRACT
Background: Complete embolization of a prosthetic heart valve is extremely rare and dangerous. This case reports a total embolization of a mechanical aortic valve and contributes to the literature regarding the diagnostic challenges related to infective endocarditis and follow-up after valvular surgery. Case summary: A 28-year-old male 11.5 years status-post a mechanical aortic valve replacement presented with acute onset of chest pain and dyspnoea while jogging. The patient lost consciousness and went into cardiopulmonary arrest with acute pulmonary oedema and circulatory shock. An echocardiogram revealed an empty aortic annulus, and a chest radiograph showed an embolized valve in the aortic arch. The patient underwent emergent removal of the embolized valve and replacement with a new mechanical aortic valve. The patient survived with minimal sequelae. At a 3-month follow-up, he had resumed work, and the only sequelae were mild left ventricular dysfunction and minor vision loss. Although he experienced no warning signs or symptoms, the most likely aetiology for embolization of the valvular prosthesis was infective endocarditis, which was revealed by re-evaluation of an echocardiogram recorded 1 month before the presentation which demonstrated a subtle motion abnormality of the valve. Conclusions: We present a case of a late complete embolization of a mechanical aortic valve most likely caused by asymptomatic infective endocarditis. The case illustrates the challenges in follow-up after valvular surgery and highlights the ultimate benefit of a well-functioning pre-hospital to hospital chain.
ABSTRACT
BACKGROUND: The elderly are vulnerable to cold and prone to accidental hypothermia, both because of environmental and endogenous factors. The incidence of severe accidental hypothermia among the elderly is poorly described, but many cases probably go unrecorded. Going through literature one finds few publications on severe hypothermia among the elderly, and, to our knowledge, nothing about extracorporeal re-warming of geriatric hypothermia victims. CASE PRESENTATION: We present a case were a 95 year-old man with severe accidental hypothermia and circulatory arrest was brought to our hospital under on-going CPR, and was successfully resuscitated with extracorporeal circulation. He was discharged to his home without physical sequelae a few weeks later. CONCLUSION: The decision whether or not to continue resuscitation of a nonagenarian can be difficult in many respects. Knowing that resuscitation with extracorporeal circulation is resource intensive may complicate the discussion. In light of our experience with this case we discuss medical and ethical aspects of modern treatment of severe accidental hypothermia.
