Infective endocarditis associated with quadricuspid aortic valve

A 26-year old Japanese woman experienced new aortic valve regurgitation associated with a preceding high fever of unknown cause. During the fever episode, although bacteremia or fungemia was not evident despite frequent blood cultures, intravenous panipenem/betamipron (PAPM/BP) gradually resulted in decline of the fever. Echocardiography and operative procedures revealed a quadricuspid aortic valve (QAV), which was composed of two equal larger cusps and two unequal smaller cusps (type f). A smaller accessory cusp was damaged but showed no active vegetation. A Medtronic Freestyle bioprosthesis was implanted using a subcoronary technique. Although the risk of endocarditis for this rare valve abnormality is not well documented, the present case may support the conventional assumption that patients with unequal small cusps are prone to endocarditis.     

Infective endocarditis of aortic valve during pregnancy: a case report

Infective endocarditis during pregnancy is uncommon but very serious. A 31-year-old woman in the 36th week of second pregnancy was admitted to a hospital because of fever, weakness, chest pain, painful skin over her right leg and dyspnea. Transthoracic echocardiography showed aortic valve vegetation and severe aortic regurgitation. Transesophageal echocardiography revealed a 18 mmx6 mm mobile vegetation, attached to the right coronary cusp. Emergency cesarean section followed with a delivery of a healthy baby. Cardiopulmonary bypass with subsequent aortic replacement with bioprosthesis was initiated immediately after cesarean section. Early echocardiographic examination and 6 months after surgery revealed normal function of aortic valve bioprosthesis and normal LV function. Clinical recognition and early echocardiographic diagnosis followed urgent simultaneous cesarean section and aortic valve replacement was lifesaving for both mother and fetus.     

Propionibacterium acnes prosthetic valve endocarditis: a case of severe aortic insufficiency.

Propionibacterium acnes rarely causes systemic disease. Few cases of P. acnes endocarditis have been reported. This report describes a 63-year-old man who presented with severe congestive heart failure. He had prosthetic valve endocarditis which resulted in severe acute aortic insufficiency. During surgery he was found to have complete disruption of the aorta and left ventricle with a false aneurysm encompassing the circumference of the aortic annulus. Cultures of the valve grew P. acnes. Thus, although P. acnes is a rare cause of endocarditis, it may pursue a very aggressive course, especially in the setting of a prosthetic valve.     

A case of microscopic polyangiitis associated with aortic valve insufficiency

Microscopic polyangiitis (MPA) is an anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis characterized by inflammation of small-sized vessels. Although there have been some reports of ANCA-associated vasculitis presenting as aortitis syndrome, MPA rarely involves large-sized vessels such as the aorta. We report an unusual case of MPA combined with severe acute aortic valve insufficiency in a 56-year-old man. He initially presented with prolonged fever, skin rash, and rapidly progressive glomerulonephritis. P-ANCA and anti-myeloperoxidase (MPO) antibodies were positive, but the c-ANCA and anti-proteinase-3 antibodies were negative. Skin biopsy of the lower leg showed necrotizing arteritis. Kidney biopsy was also performed, which revealed diffuse necrotizing and crescentic glomerulonephritis (GN) consistent with pauci-immune ANCA-associated GN. Serial echocardiographic evaluations revealed aortic valve changes and worsening acute aortic valve insufficiency over a two-month period. Despite intensive treatment, our patient developed sudden cardiac arrest and died. Our patient demonstrated typical clinical features and histopathologic findings for systemic vasculitis and had a positive anti-MPO antibody, all of which were consistent with the diagnosis of MPA. Thus, MPA may have been the cause of acute aortic valve insufficiency in this case.     

Aorto-right ventricular fistula associated with aortic valve endocarditis: a case report

A case of a 42-year old man with aortic valve endocarditis with peri-anular multi-chamber abscess formation and fistulous communication between right sinus of Valsalva and right ventricle, is presented. Transthoracic echocardiography revealed abnormal flow through the fistula confirmed at surgery. Intraoperatively the aortic valve was severely damaged with massive calcifications on the leaflets, anulus, right sinus of Valsalva and interventricular septum surrounded by fresh vegetations. Surgical procedure consisted of removal of calcification and infected tissues, followed by reconstruction of interventricular septum and aorta with pericardial patch and aortic valve replacement. Postoperative course was uneventful.     

Infective endocarditis of a bicuspid aortic valve caused by Hansenula anomala

Infective endocarditis due to Hansenula anomala developed on a bicuspid aortic valve in a 40-year-old man. H. anomala, an ascomycetous yeast, may be a member of the normal flora of the throat and alimentary tract in humans but has not been previously known to be pathogenic in humans. A past history of intravenous drug use may have contributed to the development of disease in this patient.     

Endocarditis of the pulmonary valve complicating interventricular communication. Echocardiographic detection

A 29-year old woman known to have Roger's disease was hospitalized for streptococcal endocarditis with pulmonary embolism and cerebral vascular accident. Echocardiography demonstrated vegetations on the pulmonary valve, and this was confirmed at surgery. Pulmonary valve endocarditis is a rare lesion sometimes occurring as a complication of congenital malformations with ventricular septal defect. Its prognosis is governed not so much by bacterial resistance or haemodynamic repercussions as by the risk of septic pulmonary embolism or systemic embolism. Prophylaxis is essential to avoid this dangerous complication.     

Isolated infective endocarditis of pulmonary valve in patient with interventricular septal defect]

A case of isolated infective endocarditis of the pulmonary valve in a patient with known subpulmonary interventricular septal defect that had, as major complication pulmonary septic embolization, was reported by the authors. The disease followed an insidious course, diagnosed by the presence of vegetations in the echocardiogram, some of them larger than 1 cm. They were found in the right ventricular infundibulum and in the pulmonary valve leaflets. The isolation of Estreptococcus viridans in blood cultures has confirmed the diagnosis. In spite of appropriate antimicrobial therapy, according to the antibiogram data (with Ampicillin and Gentamicin), fever lasted for more than three weeks. This event suggested medical treatment failure and the possibility of surgery was considered. However, the endocarditis eventually healed with medical therapy alone, and this unusual course with prolonged fever was presumed to be caused by lung metastatic infection secondary to septic embolization. This complication is relatively common, but lung involvement is usually a subclinical event, not responsible for such persistent fever, as happened in the case now reported. We emphasize the rarity of this case, the unusual clinical course and the discussion concerning the therapeutic options.     

Infective endocarditis of a native valve due to Acinetobacter: case report and review.

A case of community-acquired infective endocarditis of a native valve that was caused by Acinetobacter calcoaceticus subspecies anitratus is presented. The previously reported cases are reviewed, and therapy for this disorder is discussed. The presence of a transient maculopapular rash involving the palms and soles but sparing the face is suggested as a possible early clinical clue to the diagnosis. Native valve endocarditis caused by Acinetobacter species is an acute, aggressive illness that is more likely to be fatal than the prosthetic valve form; of the previously described patients, five of 15 with native valve endocarditis and one of six with prosthetic valve endocarditis died. In the appropriate clinical setting, we recommend therapy with an antimicrobial agent known to be active against Acinetobacter organisms when blood cultures are reported to yield oxidase-negative, gram-negative coccobacilli until the final identification of the microorganism is known.     

Infective endocarditis and spondylodiscitis due to posterior nasal packing in a patient with a bioprosthetic aortic valve

Infective endocarditis (IE) is a severe form of heart valve disease and is associated with a poor prognosis and high risk of mortality. We report the first known case of bioprosthetic aortic valve endocarditis associated with spondylodiscitis as a result of posterior nasal packing coated with antibiotics but without systemic antibiotic prophylaxis.     

Aortic insufficiency associated with interventricular communication. Natural history, angiographic diagnosis and surgical approach

Clinical, electrocardiographic, radiological, hemodynamic and angiocardiographic data of 12 patients with ventricular septal defect (VSD) associated to aortic regurgitation (AR) have been analyzed. The trend of evolution of the AR has been evaluated and angiographic criteria to make a correct diagnosis have been pointed out. Nine patients have been followed up for a mean of 3.8 years. The severity of AR seemed to increase only in three cases: this demonstrates that AR associated to VSD is not always a progressive disease. The usefulness of various radiological views in evidencing the anatomy of both VSD and aortic valve has been discussed and findings of left ventriculogram and aortogram are detailedly described. The site of VSD and the type of lesion of the aortic valve may be crucial for indicating surgical intervention and its type. Indication for surgery is briefly discussed. Surgical technics are shortly summarized.     

Isolated pulmonary valve endocarditis: a case report

The authors report the very rare case of isolated pulmonary valve endocarditis in the absence of classical predisposing factors and discuss the therapeutic approach. In the absence of large series, a maximum of information is developed from this new case, especially with respect to its unusual context.