• Alex Duarte.
• Chest. 2014 Mar 1;145(3 Suppl):169A.

Session TitleCritical Care CasesSESSION TYPE: Case ReportsPRESENTED ON: Saturday, March 22, 2014 at 04:15 PM - 05:15 PMPURPOSE: Treatment of Pulmonary arterial hypertension (PAH) with chronic intravenous prostanoid through a chronic tunneled catheter has been reported to be associated with bacteremia and sepsis; however bacterial endocarditis is rarely reported. Here we report a patient with idiopathic PAH receiving chronic intravenous prostacyclin that developed acute Clostridium perfringens aortic valve endocarditis.MethodsA 48 year old female with idiopathic PAH, treated with intravenous epoprostenol via subclavian catheter for five years presented with aortic valve endocarditis with regurgitation. Initially she was treated with broad spectrum antibiotic and subclavian catheter was removed. Blood cultures from the catheter tip were sterile but she remained febrile. On day 7, transesophageal echocardiography demonstrated an aortic root abscess with suspected aortic dissection. Emergent aortic root surgery was performed while continuing epoprostenol by pulmonary artery catheter. She was successfully extubated on post-operative day 2 and vasopressors and inotropes discontinued on POD 4. On POD 10, Clostridium perfringens was isolated from the culture of the aortic leaflet and six weeks of metronidazole prescribed.ResultsPatient was discharge home on inhaled iloprost (Ventavis). Three years after surgery, she remains stable on on inhaled iloprost, bosentan, and sildenafil.ConclusionsComplicated bacterial endocarditis requiring surgery in setting of pulmonary hypertension is a rare phenomenon and carries a high mortality rate of about 50%. It is a challenge to manage intra and post op hemodynamics in such cases due to elevated pulmonary vascular resistance and decrease right ventricle function with decrease systemic resistance in septic shock. In summary, we describe successful treatment of C. perfringens aortic root abscess in a patient with PAH acquired after a bout of gastroenteritis.Clinical ImplicationsSuccessful medical and surgical management of an emergent, high risk cardiac procedure based on physiological principles may be achieved.DisclosureThe following authors have nothing to disclose: Amitesh Agarwal, Alex DuarteNo Product/Research Disclosure Information.

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