{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T13:53:08Z","timestamp":1785765188594,"version":"3.56.0"},"reference-count":8,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Coronary stent infective endocarditis (IE) is a rare but serious complication of percutaneous coronary intervention. Extension to adjacent valvular structures, particularly causing cusp perforation of the aortic valve, is exceedingly uncommon. Intraoperative transesophageal echocardiography (TEE) may reveal complications not detected preoperatively, thereby changing surgical plans. We report a patient who underwent coronary angioplasty followed by persistent fever and suspicion of stent infection. Angiography detected stent related left anterior descending artery aneurysm and preoperative plan for stent explantation and revascularization was made. However, on the operating table, intraoperative TEE demonstrated perforation of the right coronary cusp of the aortic valve with severe aortic regurgitation. Surgical strategy was modified to include stent explantation, coronary artery bypass graft (CABG), and aortic valve replacement. The stent specimen showed evidence of infection. The patient\u2019s postoperative course was favorable under targeted antibiotic therapy. This case illustrates how intraoperative TEE can uncover unanticipated valvular destruction in stent-related IE and meaningfully alter surgical decision-making. Early recognition, imaging vigilance, and flexibility in surgical planning are essential in management of such rare but high-risk complications.<\/jats:p>","DOI":"10.4103\/aca.aca_268_25","type":"journal-article","created":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T19:00:30Z","timestamp":1783969230000},"page":"424-426","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Stent-Related Infective Endocarditis Revealing Aortic Cusp Perforation on Intraoperative TEE: A Case Report Altering Surgical Strategy"],"prefix":"10.4103","volume":"29","author":[{"given":"Rajesh Madavathazathil","family":"Gopalakrishnan","sequence":"first","affiliation":[{"name":"Department of Cardiac Anesthesia, Amrita Institute of Medical Sciences, Faridabad, Haryana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dheeraj","family":"Arora","sequence":"additional","affiliation":[{"name":"Department of Cardiac Anesthesia, Amrita Institute of Medical Sciences, Faridabad, Haryana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akhil","family":"Diwan","sequence":"additional","affiliation":[{"name":"Department of Cardiac Anesthesia, Medanta Medicity, Gurugram, Haryana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,7,13]]},"reference":[{"key":"R1-20260803","first-page":"299","article-title":"The impact of intraoperative transesophageal echocardiography in infective endocarditis","volume":"9","author":"Shapira","year":"2007","journal-title":"Isr Med Assoc J"},{"key":"R2-20260803","doi-asserted-by":"crossref","first-page":"25","DOI":"10.21037\/cdt-22-431","article-title":"Diagnostic performance of contemporary transesophageal echocardiography with modern imaging for infective endocarditis","volume":"13","author":"Montan\u00e9","year":"2023","journal-title":"Cardiovasc Diagn Ther"},{"key":"R3-20260803","first-page":"683","article-title":"Guidelines for the use of transesophageal echocardiography in the perioperative setting","volume":"33","author":"Nicoara","year":"2020","journal-title":"J Am Soc Echocardiogr"},{"key":"R4-20260803","first-page":"ytz171","article-title":"Infective endocarditis of the aortic valve complicated by right coronary cusp perforation","volume":"3","author":"Klassen","year":"2019","journal-title":"Eur Heart J Case Rep"},{"key":"R5-20260803","first-page":"2350","article-title":"Perforated cuspal aneurysm of aortic valve following infective endocarditis","volume":"11","author":"Kunal","year":"2022","journal-title":"J Family Med Prim Care"},{"key":"R6-20260803","doi-asserted-by":"crossref","first-page":"288","DOI":"10.33963\/KP.a2023.0085","article-title":"Iatrogenic perforation of the aortic valve cusp as a complication of percutaneous coronary intervention","volume":"81","author":"Szl\u00f3sarczyk","year":"2023","journal-title":"Kardiol Pol"},{"key":"R7-20260803","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/s43044-024-00442-0","article-title":"A case report of left circumflex stent infection and mycotic aneurysm: A rare but life-threatening complication of percutaneous coronary intervention","volume":"76","author":"Kumar","year":"2024","journal-title":"Egypt Heart J"},{"key":"R8-20260803","doi-asserted-by":"crossref","first-page":"103909","DOI":"10.1016\/j.jaccas.2025.103909","article-title":"Acute coronary stent infection with pseudoaneurysm formation and stent separation after percutaneous coronary intervention","volume":"30","author":"Flygel","year":"2025","journal-title":"JACC Case Rep"}],"container-title":["Annals of Cardiac Anaesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/aca.aca_268_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T13:10:19Z","timestamp":1785762619000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/aca.aca_268_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":8,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/aca.aca_268_25","relation":{},"ISSN":["0971-9784","0974-5181"],"issn-type":[{"value":"0971-9784","type":"print"},{"value":"0974-5181","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]},"assertion":[{"value":"2025-09-18","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-30","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}