Perforated aneurysms of left side valves during active infective endocarditis complicating hypertrophic obstructive cardiomyopathy.

The most frequent site of vegetative lesion in patients with hypertrophic cardiomyopathy is anterior mitral leaflet, due to chronic endocardial trauma arising from systolic anterior motion. We describe three cases of serious infective endocarditis complicated lesions (vegetation, aneurysm and perforation) on aortic and mitral valves, in patients with obstructive hypertrophic cardiomyopathy. In particular, we observed how severe valvular damage and dysfunction, combined with particular hemodynamic conditions, are followed by adverse clinical outcome. We performed transthoracic echocardiogram and transoesophageal echocardiography studies to define morphologic and hemodynamic features of infection, deciding the proper therapy and we planned the echocardiographic follow-up.     

肝硬化脾功能亢进合并感染性心内膜炎一例

<正>1病例资料患者男性,45岁。因呼吸困难、发热2个月余于2011年3月14日入院。患者2个月前劳累后开始出现呼吸困难,并逐渐加重,伴有全身乏力,头晕,黑矇,两次行走中出现晕厥,休息后症状可缓解。体温间断升高,波动于37.0℃～38.5℃,无寒战、盗汗、胸痛、咳嗽、咳痰,无皮疹、红斑、肌肉     

血液透析患者合并感染性心内膜炎6例临床分析

目的总结血液透析（hemodialysis,HD）患者合并感染性心内膜炎（infective endocarditis,IE）的临床特点及转归。方法回顾性分析1985年3月至2012年8月在广东省人民医院住院的6例HD合并IE患者的临床资料及随访结果。6例患者均符合IE改良的Duke诊断标准。结果入选患者6例,男1例,女5例,年龄52.8（42～68）岁;血液透析血管通路：5例自体动静脉内瘘、1例临时颈内静脉透析导管。主要临床表现及并发症：发热5例,心力衰竭恶化3例,脑栓塞3例。血培养阳性3例：2例粪肠球菌,1例光滑球拟酵母菌。超声心动图发现瓣膜赘生物5例,瓣膜穿孔1例,其中累及二尖瓣4例。3例病情恶化自动出院后1周内死亡,1例出院后4个月猝死,1例出院后17个月猝死,1例出院后4年至今仍存活。结论 IE合并HD患者在广东省人民医院尚属少见,患者易出现心力衰竭及栓塞等并发症,预后较差。     

Infective endocarditis in the setting of renal transplantation: Case report and review of the literature

The potent immunosuppressive drugs used by transplant recipients place them at risk of infections. Data on infective endocarditis (IE) in the setting of renal transplantation (RT) are sparse. We describe a 36‐year‐old woman referred to a tertiary medical center for evaluation of elevated creatinine levels 1 month after a second RT. Work‐up revealed the presence of all four of Duke's criteria: fever, persistent bacteremia, new‐onset tricuspid regurgitation, and masses suspected to be vegetation attached to the tricuspid annulus. Symptoms resolved with antibiotic treatment and fluids. Fluorodeoxyglucose‐positron emission tomography/computed tomography (FDG‐PET/CT) revealed hypermetabolic absorption in the femoral vascular graft that had been used for hemodialysis prior to transplantation. The graft was removed by open surgery, and the patient was discharged home in good condition with continued antibiotic treatment. Review of the literature yielded 73 previously reported cases of IE in renal transplant recipients. Several differences were noted from IE in the general population: lower male predominance, younger age (<60 years), absence in most cases of a preexisting structural cardiac anomaly, and more variable causative pathogens. Our case also highlights the importance of FDG‐PET/CT for detecting the source of IE and alerts clinicians to the sometimes unexpected course of the disease in renal transplant recipients.     

Infective endocarditis complicating hypertrophic obstructive cardiomyopathy.

Infective endocarditis is a rare complication of hypertrophic cardiomyopathy. It's estimated incidence is 1.4 per 1000 person/year in all patients and it increases to 3.8 per 1000 person/year in patients with left ventricular outflow obstruction. The most common site of vegetation is the ventricular aspect of anterior mitral valve leaflet. We report a case of a 43-year-old man who was admitted for mitral infective endocarditis resulting in severe mitral regurgitation complicating a hypertrophic obstructive cardiomyopathy. The patient underwent mitral valve replacement. Post-operative outcome was good with relieve of symptom and resolution of left ventricular outflow obstruction. Literature data are reviewed.     

感染性心内膜炎730例病原菌构成及药敏分析

目的 分析感染性心内膜炎（infective endocarditis,IE）患者病原菌构成及药敏结果,为本地区经验性抗感染方案的制订提供依据.方法 对2006年1月至2012年9月在广东省人民医院住院的730例IE患者的血培养结果资料进行回顾性分析.结果 （1）血培养阳性率为28.6％,病原菌构成：革兰阳性球菌157例（75.1％）,革兰阳性杆菌15例（7.2％）,革兰阴性杆菌18例（8.6％）,假丝酵母菌18例（8.6％）;最常见细菌为链球菌（40.7％）、葡萄球菌（23.4％）、肠球菌（10.5％）.（2）药敏：在革兰阳性球菌中,链球菌、肠球菌对氨苄西林和青霉素的敏感性比较,差异无统计学意义（94.9％ vs.90.6％,P=0.25; 77.8％ vs.84.2％,P=0.53）;但葡萄球菌对氨苄西林的敏感性显著高于青霉素,差异有统计学意义（58.8％ vs.7.0％,P＜0.001）.革兰阳性菌对糖肽类药物普遍敏感,氨基糖甙类对葡萄球菌及革兰阴性杆菌都有较高的抗菌活性.结论 广东省人民医院IE患者病原菌血培养阳性率低,病原菌以革兰阳性球菌多见;病原菌未明时,宜选择氨苄西林或糖肽类联合氨基糖苷类抗生素作为本区域经验性抗感染方案.     

肥厚梗阻型心肌病的起搏治疗

对药物治疗抵抗的肥厚梗阻型心肌病患者,起搏治疗日益受到重视。本文就肥厚梗阻型心肌病的病理基础,起搏治疗的机 制及对预后的影响作一简要综述。     

Hypertrophic cardiomyopathy and sports

This work summarizes current knowledge and recommendations regarding sports activities of patients with hypertrophic cardiomyopathy. Competitive sports, sports with high intensity level and burst exertion are not recommended. Also performing sports in extremely adverse environmental conditions as hot or cold weather, or high humidity is strongly discouraged; dehydration represents a risk factor as well. Recreational sports are permitted, particularly when individual risk factors and level of outflow tract obstruction are assessed in an individual patient.     

Surgical treatment of active infective endocarditis: A single center experience

Objective

This study was undertaken to examine the outcomes of surgery for active infective endocarditis.

Methods

Fifty consecutive patients underwent surgery for active infective endocarditis in a tertiary care center between January 2000 and June 2003. Modified Duke Criteria was used to include the patients in the study.

Results

Mean age of the patients was 55.72 years (range 18-89 years). Underlying heart disease was the most common cause of acute infection, accounting for 30 % of all the cases. 16 % patients had a recent dental procedure and 10 % had a recent surgical procedure. The most common infective organism was staphylococcus aureus (24%), followed by streptococcus viridians (20%). The most common indications for surgery were congestive heart failure (CHF) (52%), embolic phenomenon (18%) and septic shock (10%). Most common postoperative complication was respiratory failure (30%) followed by renal failure (24%) pacemaker implantation 22%; stroke 18%, bleeding 16% and GI bleeding 2 %. Seven out of 50 patients died during hospital course that accounts for 14% of the motility rate.

Conclusions

Surgery for endocarditis continues to be challenging and associated with high operative mortality and morbidity. Age, shock, prosthetic valve endocarditis, impaired ventricular function, and recurrent infections adversely affect long-term survival.     

Echocardiographic findings late after myectomy in hypertrophic obstructive cardiomyopathy

Postoperative echocardiograms of 50 patients undergoing myectomyfor hypertrophic obstructive cardiomyopathy between 1965 and1982 have been evaluated. In 21 patients a comparison with preoperativeechocardiograms showed that postoperatively there was a significantreduction of septal and free wall thickness, an increase ofleft ventricular end-diastolic as well as outflow tract dimensionsand a reduction or disappearance of systolic anterior motionof the mitral leaflet. Postoperative examination at intervals> 3 years revealed a significant increase of left ventricularand left atrial cavity size with unchanged contractile parametersand little reduction of left ventricular hypertrophy. In 4of12 patients evaluated > 8 years after myectomy, left ventriculardilatation was observed and 3 of these 4 patients developedcongestive heart failure. Development of leftventricular dilatationwas independent of whether a transventricular and/or transaorticapproach was used for myectomy. These data indicate that thelate course after myectomy in hypertrophic obstructive cardiomyopathymay be complicated by dilatation of the left ventricular cavity.     

Empyema and splenic abscess in infective endocarditis

We report a case of empyema secondary to splenic abscess, cured by splenectomy, in the course of an infective endocarditis caused by Streptococcus faecalis.     

Multivalvular infective endocarditis in a tetralogy of fallot

Infective endocarditis (IE) is still a problem in patients with adult congenital heart disease. Tetralogy of Fallot (TOF) is one of the most important manifestations of congenital heart disease, which carries a high risk for the development of IE. We present an 18-year-old male with TOF complicated by an aggressive form of IE involving all cardiac valves.     

合并高血压的肥厚型梗阻性心肌病患者的临床特点分析

目的：探讨合并高血压的肥厚型梗阻性心肌病（hypertrophic obstructive cardiomyopathy,HOCM）患者的临床表现、超声心动图及预后特点. 方法：入选HOCM患者80例,根据是否合并高血压将患者分为2组：合并高血压的HOCM恶者为H-HOCM组（n=43）,无高血压的HOCM患者为N-HOCM组（n=37）.随访并对比分析两组患者的临床资料. 结果：与N-HOCM组患者相比,H-HOCM组患者年龄较大,合并糖尿病者较多,左室舒张末期内径和收缩末期内径增大,室间隔厚度降低（P＜0.05）.药物治疗方面,两组患者β受体阻滞剂应用率均较高（＞80％）,H-HOCM组患者血管紧张素受体阻断剂（ARB）和血管紧张素转换酶抑制剂（ACEI）应用率明显高于N-HOCM组（P＜0.05）.随访期间两组患者临床相关事件发生率无统计学差异. 结论：合并高血压的HOCM患者呈高龄趋势,多合并糖尿病,左室呈离心性肥厚,其预后特征有待深入观察.     

Surgical treatment of caseous calcification of the mitral annulus causing mitral stenosis and mimicking the clinical picture of infective endocarditis: A case report

Among masses involving the mitral valve and annulus, caseous calcification of the mitral annulus (CCMA) is a rare disease. CCMA accounts for .63% of all mitral annular calcification (MAC) cases. The pathophysiology is still unknown. The correct diagnosis and treatment of this disease is very important to prevent complications. We present a case of giant CCMA with advanced mitral stenosis and hypertrophic cardiomyopathy, presenting with symptoms of infection and therefore a preliminary diagnosis of infective endocarditis. Because of these features, we wanted to share our case as it is the 1st case in the literature.     

Pulmonary valve vegetations and flail leaflet detected by cross-sectional echocardiography in infective endocarditis: A case report

A case report is presented of a patient with subacute bacterialendocarditis affecting the pulmonary valve. There was no pasthistory of valvular heart disease or narcotic addiction andno other valve was involved. Serial echocardiograms demonstratedthe vegetations, but only cross-sectional echocardiography showedthe flail movement of the leaflet and the size and shape ofthe vegetations.     

Hypertrophic cardiomyopathy. Proposal for a new classification

Hypertrophic cardiomyopathy (HCM) is a clinical condition, but its name has been subjected to frequent changes over the years, largely because of its morphological and functional heterogeneity, which leads the clinician who is focused on its study to have difficulty in understanding how to diagnose it and when and how to treat it. Regarding its name, it has been called in more than 75 different ways, and it has being classified with difficulty through echocardiography for more than 40 years. Today, it is necessary to understand that the diverse phenotypic behavior, as well as the evolutionary stages of the disease, must be approached in a practical and effective way, so that it easier to understand its clinical behavior and prognosis, as well as the therapeutic needs in each particular case. We review the aspects related to the name of the condition and propose a new classification that could provide the clinical and surgical cardiologist a better understanding of HCM in its various morphological and functional aspects.     

老年维持性血液透析患者感染性心内膜炎合并主动脉瓣穿孔1例

感染性心内膜炎是细菌等微生物感染心内膜所致,可侵害心脏瓣膜、心内移植物及相邻大血管,其特征性病理损害为赘生物形成。维持性血液透析(MHD)患者并发感染性心内膜炎是一种致命性疾病。MHD患者感染性心内膜炎的发生率和致死率远高于普通人群。本文回顾总结1例老年MHD患者并发感染性心内膜炎的救治经过,并分析分享治疗体会。     

Salvage heart transplantation for Mycoplasma hominis prosthetic valve endocarditis: A case report and review of the literature

Heart transplantation (HT) has been rarely performed in patients with infective endocarditis (IE) and is considered a “last resort” procedure. Orthotropic HT with bicaval technique was performed in a man with culture‐negative endocarditis. Mycoplasma hominis was later detected using 16S ribosomal DNA PCR from surgically removed valve tissue. Literature review and previous results are summarized. HT may be considered as salvage treatment in selected patients with intractable IE. In cases when there is no growth in culture, 16S ribosomal DNA PCR sequencing can be used to identify the pathogen in excised valvular tissue. Mycoplasma spp. is extremely uncommon and difficult to diagnose cause of infective endocarditis (IE). There are no proposed or defined criteria for heart transplantation (HT) in patients with refractory IE, and HT has been rarely performed in this setting. We report a case of M hominis prosthetic valve endocarditis diagnosed by 16S ribosomal DNA PCR in a patient who underwent a salvage HT. We reviewed in the literature other cases of IE caused by Mycoplasma spp.