Dental Instrumentation Leading to Multivalvular Vegetation Endocarditis in an Otherwise Healthy Immunocompetent Patient Requiring Double Valve Replacement

TL;DR

A healthy man developed heart valve infection after a dental procedure, requiring surgery to replace both valves.

Contribution

Highlights a rare case of dental-induced IE in an immunocompetent patient needing double valve replacement.

Findings

IE occurred in a patient with no cardiac risk factors following dental crown preparation.

Medical management failed due to abscess formation, necessitating mitral and aortic valve replacement.

Clinical awareness was crucial for diagnosing and managing this high-risk condition.

Abstract

Infective endocarditis (IE) is a severe condition associated with significant morbidity and mortality, often caused by bacterial seeding. Dental procedures are a well-known and well-documented risk factor for this disease. The authors present a case involving an otherwise healthy 58-year-old male with no cardiac risk factors who developed IE following a dental crown preparation. The patient’s dental-induced IE could not be managed medically due to bacterial abscess formation in the mitral and aortic valves. As a result, he developed both mitral and aortic valvopathies, characterized by mild mitral and severe aortic regurgitation, ultimately necessitating mitral valve and aortic valve replacement under cardiopulmonary bypass. This case report highlights the appropriate identification of IE, perioperative evaluation, intraoperative anesthetic management, and a review of echocardiographic findings. A heightened level of clinical awareness was critical for identifying this high-morbidity and high-mortality disease process. The report also reviews the full spectrum of diagnostic and therapeutic interventions in managing an otherwise healthy individual.

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