Infective endocarditis after alcohol septal ablation for obstructive hypertrophic cardiomyopathy

Infective endocarditis (IE) is a relatively rare but serious complication of hypertrophic obstructive cardiomyopathy. Currently, antibiotic prophylaxis is not generally recommended in these patients. We report a case of infective endocarditis in a patient after alcohol septal ablation for hypertrophic obstructive cardiomyopathy with residual left ventricle outflow tract obstruction. To the best of our knowledge, this is the first case in the medical literature demonstrating this complication in the late postprocedural period following alcohol septal ablation.     

Staphylococcus capitis endocarditis due to a transvenous endocardial pacemaker infection: case report and review of Staphylococcus capitis endocarditis.

OBJECTIVES: Newer microbiologic methods to determine the species of coagulase-negative staphylococci (CoNS) have evolved which have shown that most endocarditis due to CoNS is caused by Staphylococcus epidermidis, and far fewer by Staphylococcus warneri and Staphylococcus lugdunensis. METHODS: The recent opportunity to successfully treat a patient with methicillin-resistant Staphylococcus capitis endocarditis secondary to an infected transvenous pacemaker led to a review of the literature relating to S. capitis endocarditis. RESULTS: Thirteen previously recorded patients were identified. Twelve (86%) patients were male. Ten had endocarditis associated with a native valve, two with prosthetic valves and one with a transvenous pacemaker. Mortality was low in all 14 cases (including this case report) with only two deaths; one in a patient with a native valve and the other with a prosthetic valve. Four of the isolates were methicillin resistant but sensitive to vancomycin, which was used in the treatment of eight patients. Those patients with prosthetic cardiac devices appear to do better when the devices are surgically removed. CONCLUSIONS: CoNS as a cause of endocarditis appears to be increasing and the current ability to determine the species of these organisms should elicit the epidemiology, clinical characteristics and biomolecular mechanisms involved in the induction of valvular disease.     

Aortic regurgitation first appearing 12 years after successful septal myectomy for hypertrophic obstructive cardiomyopathy

Substantial aortic regurgitation developed in a patient with hypertrophic (obstructive) cardiomyopathy (HCM) who underwent septal myectomy. It was first noted 12 years after surgery. There was no evidence for surgical damage to the valve, subacute bacterial endocarditis, coexisting discrete subaortic stenosis or any other known etiology of aortic incompetence. This experience suggests that aortic regurgitation occasionally may be a late mode of deterioration in surgically treated patients with hypertrophic cardiomyopathy. Possible mechanisms for the development of aortic incompetence in such patients are discussed.     

Mitral valve endocarditis in hypertrophic cardiomyopathy: case report and literature review

Mitral endocarditis complicating hypertrophic cardiomyopathy occurs predominantly on the left ventricular aspect of the anterior mitral valve leaflet in the presence of outflow tract obstruction. It is a rare condition and the estimated cumulative 10 year probability of developing endocarditis in patients with obstruction is < 5%. Combined mitral valve replacement and septal myectomy has been reported in this setting. A case of community acquired Staphylococcus aureus mitral valve endocarditis is reported in a previously asymptomatic young man with hypertrophic obstructive cardiomyopathy. The potential treatment options are discussed.     

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.     

A case of Guillain-Barré syndrome following prosthetic valve endocarditis

Guillain-Barré syndrome (GBS) is an acute inflammatory demyelinating polyneuropathy associated with progressive limb weakness and areflexia. Up to now, a few cases of GBS following infective endocarditis (IE), particularly prosthetic valve endocarditis, have been reported. We present a case of a 63-year-old male patient in whom GBS developed following aortic prosthetic valve endocarditis. Although GBS is not frequently encountered in patients with IE, we believe that every clinician should consider the probable GBS in those patients suffering from distal paresthesis, progressive limb weakness and ataxia.     

Surgical treatment of infective endocarditis complicated by intracranial hemorrhage in a patient with hypertrophic obstructive cardiomyopathy

A patient with hypertrophic obstructive cardiomyopathy developed mitral regurgitation due to infective endocarditis. The patient, a 29-year-old man with a 16-year history of a severe obstructive form of hypertrophic obstructive cardiomyopathy (left ventricular outflow gradient more than 100 mmHg), was admitted with bacteremia. During medical therapy with antibiotics for six months, the patient suffered an intracranial hemorrhage without a mycotic aneurysm and developed severe mitral regurgitation due to the infective endocarditis. One month after clinical stability of the cerebral damage, the patient underwent a combined mitral valve replacement and transaortic septal myectomy. Postoperative echocardiography revealed that the left ventricular outflow gradient had decreased to 15 mmHg. Ten months after the combined operation, the patient was well and asymptomatic.     

Am seidenen Faden

We report the case of a patient with infectious endocarditis (IE) of a prosthetic aortic valve who developed an incomplete detachment from the annulus with functional occlusion of the left main coronary artery. Patients with prosthetic heart valves have the highest risk for IE which often involves the sewing ring leading to abscesses. The diagnosis is challenging and includes the evaluation and synopsis of clinical, microbiological and echocardiographic data. Transoesophageal echocardiography is mandatory in prosthetic valves. Because of the locally uncontrolled infection in abscesses urgent surgery is usually indicated. If a patient with IE is clinically deteriorating the valve should be re-evaluated quickly.     

A rare echocardiographic image of aortic prosthetic valve endocarditis complicated with paravalvular abscess,pseudoaneurysm and aorto‐right atrial fistula

Early infectious endocarditis (IE) occurs in 3% of prosthesis in the first 12 months. Early IE is more aggressive than late prosthetic valve endocarditis. Mortality remains high, despite combined medical and surgical treatment. We present a case of early IE in aortic prosthetic valve complicated with paravalvular abscess, pseudoaneurysm and aorto‐ right atrial fistula.     

The management by medical treatment of an intracranial mycotic aneurysm in a patient with infectious endocarditis with negative blood cultures and hypertrophic myocardiopathy]

A case of intracranial mycotic aneurysm due to culture-negative infective endocarditis involving a patient with hypertrophic cardiomyopathy is reported. The patient, a 22-year-old woman with no history of known prior disease, had fever, headache and focal neurologic symptoms 3 days before admission. An echocardiogram performed after admission disclosed an obstructive hypertrophic cardiomyopathy and a gross vegetation on septal leaflet of mitral valve. Cerebral angiography revealed a mycotic aneurysm involving a peripheral branch of the left middle cerebral artery. Causal agent was not identified, and empiric treatment with penicillin G and streptomycin achieved medical cure and disappearance of the aneurysm 2 weeks later. Four months after endocarditis had been cured, the patient was electively operated because of progression of mitral regurgitation. Six months later, she is asymptomatic.     

Near‐complete aortic mechanical valve dehiscence due to endocarditis reinfection

Prosthetic valve infective endocarditis (IE) is one of the most serious postimplantation complications. Prosthetic aortic valve IE constitutes 1%–6% of all prosthetic valve IE cases. We present a dramatic echocardiographic case of prosthetic aortic valve IE leading to near‐complete valve dehiscence. Echocardiographic evidence of prosthetic aortic valve rocking motion is indicative of significant dehiscence. Aside from IE, other causes and risk factors for prosthetic aortic valve dehiscence include inflammatory and autoimmune vasculitides, concomitant ascending aorta aneurysm, and aortic root calcification.     

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.     

Coagulase-negative staphylococcal endocarditis. Occurrence in patients with mitral valve prolapse

Although coagulase-negative staphylococci (CoNS) are frequent etiologic agents in prosthetic valve endocarditis, they rarely infect native heart valves. We report three cases of CoNS endocarditis in patients with mitral valve prolapse (MVP). Review of other reports of MVP-associated endocarditis and of the limited experience with CoNS infection of native heart valves suggests that our experience is not unique. Coagulase-negative staphylococcal endocarditis superimposed on MVP may be difficult to recognize and to treat. The cardiac dysfunction can be quite subtle, the clinical course indolent, the blood culture results difficult to interpret, and the response to antimicrobial agents suboptimal.     

Double Prosthetic Valve Endocarditis Caused by Streptococcus pneumoniae

Summary Infective endocarditis (IE) caused by Streptococcus pneumoniae is a rare disease. Only eight cases of pneumococcal prosthetic valve endocarditis have been described in the literature. In this report we describe the first case of pneumococcal endocarditis involving two prosthetic heart valves. The patient had pneumonia as the probable portal of entry but no predisposing conditions for invasive pneumococcal disease. Our case also illustrates the importance of transesophageal echocardiography (TEE) for the early diagnosis of IE and a timely decision for cardiac surgery. Received: August 20, 1999 · Revision accepted: November 17, 1999     

Infective endocarditis due to Staphylococcus aureus: deleterious effect of anticoagulant therapy

BACKGROUND: The use of anticoagulant therapy in patients with infective endocarditis (IE) is a controversial issue. OBJECTIVE: To study the impact of anticoagulant therapy on the clinical outcome, mortality, and cause of death in a series of patients with native and prosthetic left-sided Staphylococcus aureus IE. METHODS: This report is based on all consecutive cases of IE diagnosed at our hospital between 1975 to 1997. Clinical data, including the use of anticoagulant therapy at the time of diagnosis, were prospectively obtained, and antibiotic treatment and surgical indications were uniform throughout the study period. Computed tomographic scans of all clinical records were reviewed. RESULTS: Of 637 consecutive patients with IE, 56 had left-sided S aureus IE affecting native valves in 35 patients and prosthetic valves in 21 patients. Of the patients with prosthetic valve IE, 19 (90%) were taking oral anticoagulant therapy at the time of diagnosis while no patient with native valve IE was receiving such treatment. There were no differences between native valve IE and prosthetic valve IE in age, sex, embolic episodes, and number of central nervous system complications. Mortality was higher in prosthetic valve IE than in native valve IE (71% vs 37%; P=.02). No patient with native valve IE died due to central nervous system complications, while 73% (11 of 15 patients) with prosthetic valve IE died due to central nervous system complications. The difference in the distribution of the type of death (stroke vs other) was significant (P<.007). CONCLUSIONS: Our results suggest that in left-sided S aureus IE anticoagulant therapy is closely associated with death due to neurologic damage. According to our data, as soon as the clinical diagnosis of S aureus IE is indicated the use of anticoagulant therapy should be immediately stopped until the septic phase of the disease is overcome.     

Infective Endocarditis Complicating Hypertrophic Obstructive Cardiomyopathy: Is Antibiotic Prophylaxis Really Unnecessary?

Infective endocarditis is a relatively rare complication of hypertrophic cardiomyopathy. Infective endocarditis in hypertrophic cardiomyopathy is almost always seen in patients with outflow obstruction and is more common in those with both outflow obstruction and atrial dilatation. We present a case of culture negative mitral valve endocarditis in a previously asymptomatic woman with hypertrophic cardiomyopathy who died in the course of the disease.     

Mitral regurgitation due to ruptured chordae tendineae in patients with hypertrophic obstructive cardiomyopathy.

Mitral valve regurgitation in association with hypertrophic obstructive cardiomyopathy is usually caused by the systolic anterior motion of the anterior mitral leaflet. Recently, five patients were encountered with hypertrophic obstructive cardiomyopathy who had mitral regurgitation due to ruptured chordae tendineae. The diagnosis was confirmed in all patients during operation for left ventricular septal myectomy-myotomy (Morrow procedure). Preoperative identification of ruptured chordae tendineae as the cause of mitral regurgitation was established by transesophageal echocardiography in the three most recent cases. All patients had successful septal myectomy-myotomy for relief of left ventricular outflow obstruction, and mitral valve competence was restored by valve repair rather than by prosthetic valve replacement. The clinical course of these patients illustrates important management considerations as well as the utility of transesophageal echocardiography for diagnosis. Chordal rupture should be considered in the differential diagnosis of mitral regurgitation in patients with hypertrophic obstructive cardiomyopathy, especially in those with acute hemodynamic deterioration.     

Anticoagulation with bemiparina after intracerebral hemorrhage as complication of bacterial endocarditis on metallic prosthetic valve

We present the case of a patient with an intracerebral hemorrhage as complication of an infectious endocarditis (EI) produced by Neisseria sicca on a prosthetic mitral valve. The patient was anticoagulated previously with Acenocumarol as prophylaxis of thrombosis of the prosthetic valve. He was diagnosed as having IE and later he presented neurological symptoms as consequence of several intracerebral hemorrhagic foci. We decided to continue the anticoagulation with sodium heparin followed of Bemiparina and no new hemorrhagic complications nor thrombosis of the valve were observed after three months of the event. We have not found in the literature any case where low molecular weight heparin has been used as method of anticoagulation in these cases beyond two weeks.     

Hypertrophic obstructive cardiomyopathy and infective endocarditis: a report of seven cases and a review of the literature

Seven cases of infective endocarditis (IE) in patients with hypertrophic obstructive cardiomyopathy (HOCM) are presented in this report. The previous literature is critically reviewed, and the following points are discussed: (a) IE complicates HOCM in 5-9% of cases; (b) anatomical and haemodynamic alterations of HOCM cause microtraumas on heart valves and the endocardium; the resulting endocardial lesions represent sites for bacterial seeding as well as other congenital or acquired heart disease; (c) prognosis is worse in patients with IE associated with HOCM than in patients with IE alone or associated with congenital heart disease; (d) the most frequently isolated organisms are saprophytes; (e) most patients were exposed to bacteraemias before the onset of IE.     

Benefits of endocarditis prevention in patients with prosthetic heart valves

The beneficial effect of prophylaxis for IE was studied in 229 patients with prosthetic heart valves in whom 287 diagnostic or therapeutic interventions were performed. The prevention used was similar to that recommended by the American Heart Association. Prosthetic valve endocarditis was not observed in any of these patients. This result was compared with that of 304 patients with prosthetic heart valves, in whom without any prevention 390 similar interventions were performed during the same observation period. The incidence of prosthetic valve endocarditis occurring within 14 days after the intervention was 1.5/100 interventions (n = 6). All patients had to be reoperated. One patient died perioperatively. Two more patients developed prosthetic valve endocarditis 8 and 13 weeks, respectively, after the initial intervention. This retrospective study documents the benefit of the prophylaxis for IE used.