Extracranial mycotic aneurysms in infective endocarditis

Nine of 217 (4.15%) patients with infective endocarditis who were followed from October 1978 to February 1984 had extracranial mycotic aneurysms (MA). Age range of patients was 6-43 years (mean of 24.8 years) and 7 were male. Etiologic agents were Streptococcus viridans (3 cases), Staphylococcus aureus (2 cases), Staphylococcus epidermidis (1 case), and Pseudomonas aeruginosa (1 case). Two patients had negative blood cultures. The MA involved the arteries of the limbs (5 cases), thoracic (3 cases), and abdominal (1 case) arteries. The diagnosis was made by means of physical examination (5 cases), chest roentgenogram (2 cases), ultrasound examination (1 case), and aortography (1 case), at hospital admission (2 cases), early or before antibiotic therapy (2 cases), and from two days to six months after finishing antibiotic therapy (5 cases). All but one patient were operated upon due to MA; bleeding occurred in three cases; surgery was an emergency procedure in one case and performed from 8 to 58 days after the diagnosis of the MA in the others. Signs of infection at surgery were found in one case. In the others, further antibiotic therapy was not administered. There were no limb losses in the peripheral MA. Four patients received surgical treatment for endocarditis. There was one in-hospital death and another one 6 months later due to heart failure.     

Bilateral infective endocarditis

Two patients presenting with simultaneous right- and left-sided infective endocarditis requiring surgical intervention are reported. One patient developed aortic and pulmonic valve endocarditis following dental extraction, while the second patient developed mitral and tricuspid valve endocarditis secondary to a large body burn. The bilateral semilunar valve endocarditis was treated by porcine aortic valve replacement and debridement of the pulmonic valve. The bilateral atrioventricular valve endocarditis was treated by mitral and tricuspid valve replacement with porcine valves. The frequency and clinical settings in which this condition is likely to present are discussed.     

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。     

Robotic mitral valve repair in infective endocarditis

Background

Robotic mitral surgery is the most common robotic cardiac procedures. However, in mitral endocarditis the repair become more challenging especially in minimally approach. We applied robotic surgery in mitral endocarditis repair and reviewed our surgical methods and results.

Patients

From January 2012 to December 2013, 12 patients with mitral endocarditis in National Taiwan University Hospital were operated via robotic assisted repair. Age of them was among 21 to 65 years old, mean 43.

Results

The vegetation involves anterior leaflet in 3, posterior leaflet in 8 and commissural leaflet in 4. Mean cardiopulmonary bypass time is 124 minutes and cross clamp time is 89 minutes. There was no stroke and no operation death. Mitral valve repair technique including anterior leaflet patch augmentation in 2, direct closure of rupture hole on anterior leaflet in one, plication commissural leaflet in 2, and artificial chordae in 10. There was no mitral regurgitation detected immediately after weaning of cardiopulmonary bypass. All of them got free-from-regurgitation or -stenosis rate was 100% at one-year follow.

Conclusions

Although mitral infective endocarditis is complex and difficult to repair, robotic mitral repair in infective endocarditis is feasible. Even in the complex repair group, the cardiopulmonary bypass time is not prolonged and the result is good.     

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.     

Intravenous thrombolysis is unsafe in stroke due to infective endocarditis

Embolic stroke is the most common neurological complication of infective endocarditis and a major source of morbidity and mortality. Septic embolism is considered a contraindication to intravenous thrombolysis in patients with ischaemic stroke because of concerns over an increased risk of intracranial haemorrhage. We describe a patient with occult endocarditis who was treated with thrombolysis for acute stroke and review other cases reported in the literature.     

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.     

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.     

Clinical considerations regarding infective Libman-Sacks endocarditis

A case of aortic infective endocarditis due to Hemophilus paraphrophilus in a patient with previous Libman-Sacks endocarditis is presented. Suggestions regarding antibiotic prophylaxis are made concerning patients with systemic lupus erythematosus.     

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.     

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     

Papillary muscle rupture secondary to infective endocarditis

Rupture of the mitral papillary muscle due to infective endocarditis is a very rare complication. There is no report regarding anterolateral papillary muscle rupture as a complication of infective endocarditis in the literature. We decided to report a case of anterolateral papillary muscle rupture due to infective endocarditis. Our case, which will be discussed later on, differs also in many ways from that in the literature.     

二叶式主动脉瓣畸形合并感染性心内膜炎的临床及预后分析

目的:总结二叶式主动脉瓣畸形合并感染性心内膜炎的临床特点及治疗,明确影响主动脉瓣感染性心内膜炎预后的因素。方法:将2001-01-2010-12期间我院收治的符合DUKE诊断标准的自体主动脉瓣感染性心内膜炎患者98例,分为二叶式主动脉瓣畸形组和三叶式主动脉瓣畸形组,评价临床表现、实验室检查、超声心动图、瓣膜形态、手术治疗与死亡率的相关性。结果:31例(31.6%)二叶式主动脉瓣感染性心内膜炎患者更年轻,易发生瓣周脓肿(35.5%)。二叶式主动脉瓣是瓣周脓肿的独立预测因素(OR=4.015,95%CI 1.307～12.335,P<0.05)。二叶式主动脉瓣畸形组与三叶式主动脉瓣畸形组的早期手术及院内死亡率均差异无统计学意义。严重心力衰竭(OR=8.955,95%CI1.811～44.687,P<0.01)及未控制的感染(OR=0.170,95%CI0.041～0.697,P<0.05)是主动脉瓣感染性心内膜炎死亡的独立预测因素。瓣膜手术可以降低主动脉瓣(OR=0.222,95%CI0.006～0.822,P<0.05)及二叶式主动脉瓣(OR=0.320,95%CI0.090～1.140,P<0.05)感染性心内膜炎的死亡率。结论:二叶式主动脉瓣畸形是主动脉瓣感染性心内膜炎常见的瓣膜异常。二叶式主动脉瓣感染性心内膜炎的患者更年轻,易发生瓣周脓肿。手术治疗可降低二叶式主动脉瓣感染性心内膜炎的死亡率。     

Long term results of mechanical prostheses for treatment of active infective endocarditis

OBJECTIVE—To analyse the long term results of mechanical prostheses for treating active infective endocarditis.
DESIGN—Prospective cohort study of a consecutive series of patients diagnosed with infective endocarditis and operated on in the active phase of the infection for insertion of a mechanical prosthesis.
SETTING—Tertiary referral centre in a metropolitan area.
RESULTS—Between 1975 and 1997, 637 cases of infective endocarditis were diagnosed in the centre. Of these, 436 were left sided (with overall mortality of 20.3%). Surgical treatment in the active phase of the infection was needed in 141 patients (72% native, 28% prosthetic infective endocarditis). Mechanical prostheses were used in 131 patients. Operative mortality was 30.5% (40 patients). Ninety one survivors were followed up prospectively for (mean (SD)) 5.4 (4.5) years. Thirteen patients developed prosthetic valve dysfunction. Nine patients suffered reinfection: four of these (4%) were early and five were late. The median time from surgery for late reinfection was 1.4 years. During follow up, 12 patients died. Excluding operative mortality, actuarial survival was 86.6% at five years and 83.7% at 10 years; actuarial survival free from death, reoperation, and reinfection was 73.1% at five years and 59.8% at 10 years.
CONCLUSIONS—In patients surviving acute infective endocarditis and receiving mechanical prostheses, the rate of early reinfection compares well with reported results of homografts. In addition, prosthesis dysfunction rate is low and long term survival is good. These data should prove useful for comparison with long term studies, when available, using other types of valve surgery in active infective endocarditis.


Keywords: infective endocarditis; surgery; mechanical prosthesis     

Aspirin to prevent growth of vegetations and cerebral emboli in infective endocarditis.

The incidence of stroke on cranial computed tomography (CT) and change in echocardiographic vegetation area was prospectively compared in a preliminary observational study involving nine patients with infective endocarditis randomized to either low-dose aspirin (75 mg d-1, Group I, n = 4) or no aspirin (Group II, n = 5). Two symptomatic cerebral infarcts and one myocardial infarct occurred in the controls, compared to no events in patients on aspirin during a total observation period of 343 d (range 28-49 d). The mean vegetation area decreased in the aspirin group (mean change = -0.24 cm2), compared to an increase in controls (mean change = +0.35 cm2). The platelet half-life (normal range 5-6 d), which was measured using Indium-111 radiolabelling, tended to be lower in Group II (4.6 +/- 0.2 vs. 3.9 +/- 0.5 d). No side-effects or complications attributable to aspirin were observed. A possible role for adjunctive aspirin therapy in the prevention of embolic complications in infective endocarditis is suggested, and warrants further study.     

Clinical relevance of vegetation localization by transoesophageal echocardiography in infective endocarditis.

Infective endocarditis is associated with significant morbidity and mortality, with valvular destruction and congestive heart failure being more common in patients with echocardiographically discernible vegetations. The transoesophageal approach affords consistently high quality images with excellent structural resolution. Two-hundred and eighty-one patients with clinically suspected infective endocarditis were studied, to evaluate the prognostic value of ascertaining the site of vegetations. Among them were 118 patients with vegetations attached to the aortic or mitral valve. These patients were followed for a mean period of 14 months. Mitral valve vegetations were associated with a significantly higher incidence of embolic events than vegetations on aortic valves (25% vs 9.7%). The incidence of abscess formation was higher in aortic than in mitral valve endocarditis (6% vs 0%), as were the need for surgical intervention (11% vs 5.5%) and mortality (1.6% vs 0%) respectively). Bivalvular endocarditis was associated with an increased rate of complications: embolism (50%), abscess formation (15%), surgery (35%) and mortality (10%). By multivariate analysis, echocardiographically accessible risk factors for subsequent embolism were a vegetation size of more than 10 mm and mitral valve involvement. Risk factors associated with in-hospital fatality were embolism, a vegetation size of more than 10 mm, and Staphylococcus aureus infection. Our data suggest that the site influences both the rate and the type of complications. Precise echocardiographic visualization of vegetations helps to stratify patients into a high-risk sub-group, perhaps warranting early prophylactic surgical intervention. Transoesophageal echocardiography may play an important role in assessing the clinical outcome for these patients.     

HIV抗体阳性静脉药瘾者右心感染性心内膜炎临床分析

目的探讨静脉药瘾者有心感染性心内膜炎（right—sided infective endocarditis,RIE）并人类免疫缺陷病毒（human immunodeficiency virus,HIV）抗体阳性的临床特点。方法回顾性分析21例HIV抗体阳性的RIE患者临床资料,着重分析患者的检查结果和治疗情况。结果①无业男青年居多,无基础心脏病,静脉吸毒时间0．5年～5年不等;②均有发热、浅表静脉炎性反应及肺损害等;③心脏损害以三尖瓣受损为主,部分有肺动脉瓣受损,少数并发二尖瓣受累;④实验室检查多有贫血,白细胞升高及低蛋白血症,血培养阳性率达61．9％,以金黄色葡萄球菌居多;⑤超声心动图检出三尖瓣赘生物达100％,符合右心感染性心内膜的特点;⑥预后较差。结论静脉药瘾是RIE与HIV感染的致病原因,RIE与HIV感染共患,相互影响,增加RIE的严重性及治难性,临床症状重,预后较差。     

感染性心内膜炎患者血液中分离到羊种布鲁菌

目的从患者血液中分离出的病原菌进行生物学性状研究和种及型的临床鉴定;探讨布鲁菌病在热带海岛海南的流行特点。方法按布鲁菌标准鉴定方法进行细菌学实验(包括形态学、培养特性、生化特征、血清学试验和噬菌体试验等),并对患者的流行病学、临床资料、实验室资料进行系统分析。结果患者血液中病原微生物的形态学、培养特性、生化特征、血清学诊断和噬菌体诊断结果均符合羊种布鲁菌生物2型;与我国近几年分离到的羊种布鲁菌生物1型和3型相比明显不同;羊种布鲁菌尿素酶试验为不定(V),也没有强阳性的报告,而海南分离株为强阳性。结论海南省首次发现人布鲁菌病,由羊种布鲁菌2型引起。该病在海南省存在分散的点状流行,应引起医务人员及有关部门的重视。