Published: March 27, 2026
Patient is a 61-year-old male with a past medical history significant for mitral valve prolapse (diagnosed at age 14). He presented to a Norton Immediate Care Center location with complaints of rash on his lower legs. He had been having shortness of breath for several months after a back injury left him with severe pain and decreased mobility. Patient reported that he had been using high doses of ibuprofen frequently to treat his pain. On exam, he was found to have 3-plus pitting edema, petechiae on all his extremities, increased breathing difficulties and a large hernia. He was sent to Norton Brownsboro Hospital emergency department for further evaluation.
Patient was admitted from the emergency department after labs showed an elevated B-type naturietic peptide (BNP), mildly elevated troponin and evidence of pulmonary edema on chest X-ray. Additionally, he was found to be anemic with hemoglobin at 6.6 grams per deciliter. He underwent a transthoracic echocardiogram (echo) that showed a normal ejection fraction, but there was concern for mitral and aortic valve endocarditis. Blood cultures were drawn. Results were positive for Streptococcus viridans . He subsequently underwent a transesophageal (echo) and left heart catheterization that showed multiple large vegetations on his mitral and aortic valves, with associated severe mitral regurgitation and mild aortic regurgitation and significant stenosis of the distal left main coronary artery.
The patient was started on antibiotics for bacterial endocarditis with bacteremia. He underwent a colonoscopy to evaluate his anemia and was found to have nonbleeding arteriovenous malformations. Hematology evaluated the patient, and he was diagnosed with cryoglobulinemia that was treated with rituximab, steroids and plasmapheresis. He was transferred to Norton Audubon Hospital for surgical evaluation.
The patient underwent double coronary artery bypass grafting (CABG) with bioprosthetic aortic and mitral valve replacements. He had difficulty weaning from cardiopulmonary bypass despite intra-aortic balloon pump (IABP) placement, and the decision was made to cannulate the patient for veno-arterial extracorporeal membrane oxygenation (VA ECMO).
The patient was admitted to the cardiovascular intensive care unit where a team of specialists, including cardiothoracic surgery, heart failure cardiology, interventional cardiology, pulmonary, nephrology, infectious diseases and hematology all assisted in his management.
His hospitalization was further complicated by the development of bradycardia and arrhythmias. A temporary pacemaker was placed; later this was converted to a permanent pacemaker. He also developed Klebsiella pneumonia.
Nine days after his open heart surgery, he was successfully decannulated from VA ECMO. Twelve days after his surgery, his IABP was removed. He continued to improve with support of the team of specialists. After a 46-day hospital stay, he was successfully discharged to acute rehabilitation. He was seen by heart failure specialists with the Norton Heart & Vascular Advanced Heart Failure and Recovery Program frequently after his extensive hospitalization and he has made a complete recovery.