Porcine bioprosthetic aortic valve endocarditis with ring abscess and aortic stenosis

Porcine bioprosthetic valve endocarditis is an infrequent but serious complication of valve replacement surgery. Ring (or annular) abscess is a frequent finding in mechanical valve endocarditis. In contrast, porcine valve endocarditis most often involves the cusps, and annular infection is uncommon. Porcine valvular dysfunction secondary to endocarditis usually takes the form of incompetence, whereas stenosis is less frequent. We report a case of a 76-year-old female who developed endocarditis with Staphylococcus epidermidis nine months after placement of a Carpenter-Edwards porcine aortic valve. Her initial presentation included complete heart block and moderate aortic stenosis. Transesophageal echocardiography aided the diagnosis by demonstrating large vegetations, while transthoracic echocardiography showed only slight thickening of the valve leaflets. At operation, there was a circumferential abscess around the sewing ring causing valve dehiscence and virtual discontinuity of the aorta from left ventricle. Valve degeneration and organisms within the cusps were observed on microscopy. This case illustrates two infrequent complications of porcine aortic valve endocarditis, namely massive annular abscess with invasion of the conducting system and aortic stenosis. It also demonstrates the utility and limitations of transesophageal echocardiography in the diagnosis of this disorder.     

Infective tricuspid valve endocarditis due to abscess of an endogenous arteriovenous fistula in a chronic hemodialysis patient

Patients on chronic hemodialysis are at high risk for endocarditis due to prosthetic access devices. Right-sided endocarditis without any predisposing factors is rare in dialysis patients. A 76-year-old female, who had chronic renal failure had been treated by hemodialysis and had a permanent pacemaker implanted, was admitted to our hospital with a high fever and lumbago after abscess formation at an autogenous arteriovenous fistula for hemodialysis. Methicillin Resistant Staphylococcus Aureus was identified by blood culture examination. Echocardiography revealed vegetation attached to the tricuspid valve. Chest X-ray and perfusion lung scintigraphy showed pulmonary infarction, perhaps due to vegetation-derived emboli. Computed tomography also showed pyogenic spondylitis in L4 and L5. Repeated vascular punctures even of autogenous grafts expose dialysis patients to bacteremia and imply a higher risk of infectious endocarditis.     

主动脉瓣畸形患者感染心内膜炎病原菌分布及耐药性监测

目的 探讨主动脉畸形患者感染心内膜炎的病原菌分布特点及其耐药性,对临床治疗进行指导.方法 选取二叶式主动脉瓣畸形感染心内膜炎患者153例,对其临床资料进行回顾性分析,并行病原菌分离和耐药性分析.结果 153例患者共检出病原菌161株,其中革兰阳性菌123株,占76.40％,革兰阴性菌30株,占18.63％,真菌8株,占4.97％,排名前5位病原菌依次为酿脓链球菌、凝固酶阴性葡萄球菌、金黄色葡萄球菌、大肠埃希菌、铜绿假单胞菌,分别占37.27％、24.22％、13.04％、9.32％、3.73％;酿脓链球菌、凝固酶阴性葡萄球菌及金黄色葡萄球菌对利奈唑胺、万古霉素和替考拉宁的耐药率均为0,酿脓链球菌对青霉素、头孢曲松、头孢噻肟以及左氧氟沙星的耐药性相对较低＜7.00％,而对克林霉素和红霉素的耐药性相对较高＞50.00％;凝固酶阴性葡萄球菌仅对利福平较为敏感,耐药率＜6.00％,而对青霉素类药物、头孢类药物和红霉素均表现出了很高的耐药性,耐药率＞80.00％;金黄色葡萄球菌除对青霉素耐药性特别高以外,对其他药物的耐药率均＜30.00％,其中对头孢唑林、头孢呋辛、庆大霉素以及利福平的耐药性＜10.00％.结论 二叶式主动脉瓣畸形感染心内膜炎患者病原菌存在多样性,在治疗的早期可根据经验给予联合用药治疗,并根据细菌培养和药敏试验结果随时对药物进行调整.     

产前心超诊断永存左上腔静脉引流入左房的价值

文章回顾性分析5例经产前超声诊断为永存左上腔静脉引流入左房的超声资料及随访结果,总结其超声声像图特点,探讨产前超声诊断永存左上腔静脉引流入左房的价值。     

老年高血压病患者左心房扩大与左室结构及功能的关系

目的：探讨老年高血压患左心房扩大的相关因素。方法：应用彩色多普勒超声心动图检测了101名老年高血压病患左心房改变，与48例老年正常人组比较。同时检测了醛固酮（ALD），血管紧张素I、Ⅱ（AT2，AT2），甲状旁腺激素（PTH），环磷酸腺苷（CAMP），胰岛素（Ins)等。结果：老年高血压患左心房扩大，AID，AT2，Ins升高，左房内径和容积与左室内径、重量、容量和左室舒张功能（Av/Ev)，及血压、ALD、AT2显正相关（P＜0．01）。结论：老年高血压患左心房扩大与血压，AID，AT2及左室结构和功能有关。     

老年高血压病患者左心房扩大与左室结构及功能的关系

目的探讨老年高血压患者左心房扩大的相关因素.方法应用彩色多普勒超声心动图检测了101名老年高血压病患者左心房改变,与48例老年正常人组比较.同时检测了醛固酮(ALD),血管紧张素Ⅰ、Ⅱ(AT1,AT2),甲状旁腺激素(PTH),环磷酸腺苷(CAMP),胰岛素(Ins)等.结果老年高血压患者左心房扩大,ALD,AT2,Ins升高,左房内径和容积与左室内径、重量、容量和左室舒张功能(Av/Ev),及血压、ALD、AT2显著正相关(P＜0.01).结论老年高血压患者左心房扩大与血压,ALD,AT2及左室结构和功能有关.     

The diagnostic challenge of infective endocarditis: cutaneous vasculitis leading to the diagnosis of infective endocarditis.

BACKGROUND: Signs and symptoms of infectious endocarditis are protean. They result from destruction of cardiac endothelium, metastatic embolization, hematogenous seeding, and immune complex deposition. Embolic manifestations of infectious endocarditis can mimic several other pathologic conditions and make the diagnosis of infectious endocarditis difficult. METHODS: We describe a case of cutaneous vasculitis leading to the diagnosis of infectious endocarditis. A review of the literature highlights the variable clinical presentations and key diagnostic strategies in the evaluation of infectious endocarditis. RESULTS AND CONCLUSION: Infective endocarditis has protean clinical symptoms and signs and can be a challenging diagnosis. Being alert to the condition is crucial, and where a high clinical probability exists despite a negative transthoracic echocardiogram, diagnostic evaluation with transesophageal echocardiograph is required.