Prosthetic Valve Endocarditis
Prosthetic valve endocarditis is a significant infection. It is often serious, and may result in a complicated course leading to valvular malfunction. We present the case of a 50-year-old male with an aortic Medtronic Hall valve, who presented with loss of his normal metallic click. A transthoracic echocardiogram confirmed the diagnosis of endocarditis and of an aortic-root abscess. Blood cultures were positive for nutritionally deficient Streptococcus. He underwent successful surgery and later was discharged. Patients with mechanical heart valves are often bothered by the metallic sound. It can interfere with their daily life. However, the loss of the click may indicate valvular dysfunction, dehiscence of the prosthesis, and/or tissue infection with abscess formation.

Sixty-five to seventy-five percent of patients with mechanical heart valves are disturbed by the metallic clicks, the Edwards-Duromedics valve (Baxter-Edwards, Inc., Santa Ana, CA) being the loudest. Prosthetic valve endocarditis (PVE) is not uncommon, and often has consequences leading to valve malfunction. Patients with PVE present with symptoms and signs similar to native valve endocarditis, ie, fever, new or changing heart murmur, electrocardiographic conduction disturbances, and positive blood cultures. However, the presentation can be subtle, and as a result, delay the diagnosis and treatment. We report a case of PVE in which loss of the normal valvular click was the main presenting feature.