Gemella haemolysans spondylodiscitis: a report of two cases

We report on two cases of infective spondylodiscitis caused by Gemella haemolysans in otherwise healthy patients. This organism has only rarely been identified as a cause of bone and joint infection, with only two previous reports of infective spondylodiscitis. We describe the clinical features, investigations and treatment options.     

A case of heart operation in infective endocarditis after brain surgery for mycotic cerebral aneurysm

Complications of infective aneurysm are not rare in patients with infective endocarditis. An optimal timing of heart operation after brain surgery for hemorrhage is controversial. We reported a 19-year-old woman with ventricular septal defect (type II), mitral regurgitation and ruptured cerebral aneurysm with infective endocarditis. Cerebral aneurysm had been ruptured during infective endocarditis treatment. Resection of the aneurysm was performed next day. Vessel spasm occurred, resulting in cerebral infarction 7 days after the operation. Conservative therapy was continued for infective endocarditis until heart failure appeared. Heart operation was successfully performed 41 days after brain surgery without cerebral complication. This report indicates that heart operation might be avoided at the early postoperative stage of brain surgery for cerebral aneurysm with hemorrhage.     

An alternative surgical approach for aortic infective endocarditis: vegetectomy

We describe a case of successful vegetectomy of the aortic valves for early infective endocarditis. An aortic vegetectomy was performed as an alternative to valve replacement for a 54-year-old man with three vegetations and mild regurgitation in aortic valve due to infective endocarditis. Postoperative clinical course was without signs of recurrent infection after follow-up of 19 months, and transesophageal echocardiography demonstrated aortic valve competence. We would suggest that vegetectomy with valve sparing may be a viable option in the context of early infective endocarditis involved aortic valve in selected patients.     

Mitral valve repair during acute phase infective endocarditis with extensive destruction of the anterior leaflet rough zone and cerebral infarction

Some reports suggest that mitral valve repair has good outcomes and may, therefore, be the preferred surgical approach in patients with active infective endocarditis (Doukas et al. in Heart 92(3):361-363, 2006); Ruttmann et al. in J Thorac Cardiovasc Surg 130(3):765-771, 2005; Sternik et al. in J Heart Valve Dis 11(1):91-97, 2002). However, in cases of active infective endocarditis of the mitral valve, extensive destruction of valvular tissue may make reliable valve repair difficult. Moreover, the timing of valve repair for active infective endocarditis remains controversial, especially in patients having cerebral complications. We present a case of a 34-year-old woman who had active infective endocarditis of the mitral valve complicated by multiple acute cerebral infarctions from septic embolisation. We could successfully carry out mitral valve repair 36?h after the diagnosis of active infective endocarditis and cerebral infarction was made. Her postoperative course was uneventful, and the patient remained in good health without recurrence of infective endocarditis and neurological complications.     

Repair of aortic root abscess cavity with Gelatin-Resorcin-Formol biological glue

We report a case of infective endocarditis in which Gelatin-Resorcin-Formol biological glue enabled safe and effective aortic root repair to be performed in a 57-year-old man with infective endocarditis and subsequent aortic valve insufficiency.     

Successful surgical management of patients with infective endocarditis associated with acute neurologic deficits

Subjects were 2 patients with neurologic deficits due to infective endocarditis. The first, a 30-year-old woman with acute ischemic stroke, was found to have vegetation from infective endocarditis as the embolic source. Two weeks after she experienced an acute ischemic stroke, we conducted elective cardiac surgery. The second, a 16-year-old girl with infective endocarditis, suffered a ruptured mycotic aneurysm in the left carotid system complicated by intracranial hemorrhage. We conducted a successful staged mitral valve replacement following craniotomy.     

A case of membranous septal aneurysm associated with infective endocarditis

A 43-year-old man with membranous septal aneurysm associated with infective endocarditis was reported. In this case, the stream of the shunt through VSD was directly oriented toward the atrial surface of the tricuspid anterior cusp and made it unusual form. The focus of infective endocarditis was located on that cusp, and he underwent tricuspid valve replacement with VSD closure. The post-operative course was uneventful. We discussed the tricuspid anterior cusp deformed by the jet stream of the shunt and the relationship between the aneurysm and the infective endocarditis.     

Staged laparoscopic splenectomy and valve replacement in splenic abscess and infective endocarditis

Splenic abscess is a rare clinical entity that is most commonly associated with infective endocarditis. Valve replacement in the setting of an unaddressed splenic abscess is associated with a high incidence of prosthetic valve infection and death. We describe 2 patients with infective endocarditis and splenic abscess treated by laparoscopic splenectomy followed by valve replacement.     

Infective endocarditis complicated by rupture of intracranial mycotic aneurysm during pregnancy

We report a case of a pregnant woman who developed infective endocarditis further complicated by an intracranial mycotic aneurysm. She presented with massive intracranial haemorrhage in the third trimester of pregnancy. The disease process of infective endocarditis and peri-operative management of ruptured intracranial mycotic aneurysm during pregnancy are discussed.     

Surgical treatment of infective endocarditis in childhood--report of 3 cases

This is the case report of 3 surgical patients with infective endocarditis in childhood. Case 1: A 8 year-old boy was admitted with high fever and congestive heart failure. Aureus staphylococci were identified by blood culture. Echocardiogram showed a vegetating mass on the posterior mitral leaflet. This patient was cured by emergency mitral valve replacement during the active phase of infection. Case 2: A 3 year-old girl was admitted with infective endocarditis related to VSD. Viridans streptococci were identified by blood culture. Echocardiogram showed a vegetating mass on the septal tricuspid leaflet. After successful antibiotic therapy, this patient underwent the closure of VSD and tricuspid valvuloplasty. Case 3: A 7 year-old boy was admitted with infective endocarditis related to VSD. Aureus staphylococci were identified with blood culture. Echocardiogram showed a vegetating mass on the anterior tricuspid leaflet and moderate tricuspid regurgitation. After successful antibiotic therapy, this patient underwent the closure of VSD and tricuspid valvuloplasty. We believe that echocardiography plays an important role in the diagnosis and management of infective endocarditis and that tricuspid valvuloplasty is the method of first choice in treatment of the patient with regional tricuspid infective endocarditis.     

Repair of a Recurrent Pseudoaneurysm of the Ascending Aorta in an Atomic Bomb Survivor with Myelodysplastic Syndrome

Abstract   The occurrence of infective aortic pseudoaneurysms tends to be intractable and difficult to treat. We experienced a very rare case of a recurrent infective pseudoaneurysm in the ascending aorta that occurred after cardiac surgery in an atomic bomb survivor with myelodysplastic syndrome. The pseudoaneurysm was successfully repaired using a femoral artery autograft with an omentopexy and the patient recovered well without any recurrence.     

Surgical management of infective endocarditis

We reviewed fourty-six patients who had undergone surgery for infective endocarditis in the past fifteen years and identified risk factors affecting the outcome. Twenty-nine patients had infection of the native valve only, 11 had infective endocarditis associated with congenital heart disease, and 6 had prosthetic valve endocarditis. Overall hospital mortality was 6.5%. Prosthetic valve endocarditis carried a higher mortality (33%) than native valve endocarditis (3.4% or congenital heart disease with infective endocarditis (0%). For the patients with active endocarditis, the early mortality rate was higher (13%) than with inactive endocarditis (3.2%). Staphylococcal infections were more likely to cause severe valve destruction and residual infection than streptococcal infection. Our results indicated that surgical management of infective endocarditis should be done after the completion of adequate antibiotic therapy. Early diagnosis should reduce the mortality, prevent fatal complications, and lead to qualitative improvement of infective endocarditis.     

Endovascular treatment for intracranial mycotic aneurysms prior to cardiac surgery.

The management of patients with infective endocarditis complicated by intracranial mycotic aneurysms is controversial. We present the case of a 21-year-old man who suffered from mitral regurgitation with small vegetations due to infective endocarditis. The problem was associated with a ruptured aneurysm on the right anterior cerebral artery and an unruptured aneurysm on the left middle cerebral artery. Endovascular embolization of these aneurysms and subsequent mitral valve repair led to a successful outcome.     

Cardiobacterium hominis endocarditis. Report of one case and review of the literature

We report a case of infective endocarditis due to Cardiobacterium Hominis. This organism has rarely been recognized in the past as a human pathogen on the cardiac valves. This patient escaped early diagnosis, but he was successfully treated with parenteral ampicillin followed by elective aortic and mitral valve replacement. The bacteriological characteristics of this unusual cause of infective endocarditis are discussed and the world literature is reviewed.     

Successful aortic valve replacement for infective endocarditis in a patient with severe liver cirrhosis.

Patients with liver cirrhosis are prone to the development of severe complications associated with high mortality rates after major surgery, especially cardiac surgery using cardiopulmonary bypass (CPB). We report the case of a 65-year-old man with acute infective endocarditis and aortic valve perforation, complicated by non-cardiac liver cirrhosis (Child-Pugh class B). After careful preoperative anti-inflammatory and systemic support treatment, we successfully treated infective endocarditis-induced aortic valve perforation by performing aortic valve replacement (AVR).     

Renal infarction with renal abscess onset due to infective endocarditis: a case report

A 68- year-old male was referred with fever and urinary tract infection. Abdominal computed tomography showed a right renal infarction with abscess and abscesses in the liver and spleen. Cardiac ultrasonic examination showed a vegitation in the aortic valve. Based on these findings, the patient was diagnosed with infective endocarditis and multiple abdominal organ abscesses. The renal infarctions and multiple abscesses probably developed due to dissemination of warts associated with infective endocarditis. We performed emergency valve replacement at the cardiovascular surgery unit at our hospital. Improvements were made in the multiple abscesses after subsequent treatment with an antibiotic agent. The renal diseases associated with infective endocarditis were found to be diverse and we concluded that it is important to understand the conditions of the disease correctly for appropriate treatment.     

Spontaneous splenic rupture following mitral valve replacement for infective endocarditis successfully managed with splenic artery embolisation

We report a rare case of infective endocarditis complicated by postoperative splenic rupture. A patient underwent urgent mitral valve replacement for infective endocarditis believed to be associated with a recent spinal surgical intervention. The patient developed haemodynamic compromise on the third day postoperatively. Computed tomography showed a splenic rupture as the cause. The patient underwent emergency radiological intervention with coil embolization avoiding the need for a splenectomy and was discharged home.     

Quadricuspid aortic valve complicated with infective endocarditis: report of a case

Congenital quadricuspid aortic valve is a rare cardiac malformation with an unknown risk of infective endocarditis. We report a case of quadricuspid aortic valve complicated with infective endocarditis. A 53-year-old Japanese woman was hospitalized with leg edema and a fever of unknown origin. Corynebacterium striatum was detected in the blood culture. Echocardiography demonstrated a quadricuspid aortic valve with vegetation and severe functional regurgitation. The condition was diagnosed as a quadricuspid aortic valve with infective endocarditis, for which surgery was performed. The quadricuspid aortic valve had three equal-sized cusps and one smaller cusp (type B according to Hurwitz classification). We dissected the vegetation and infectious focus and implanted a mechanical valve. Following the case report, we review the literature.     

Aortic root replacement with free-style stentless valve for aorto-left and right ventricular communication due to infective endocarditis; report of a case

Aortic root abscess remains a major determinant of both early and late results of surgical treatment of endocarditis. This complication rarely progresses to intracardiac shunt followed by cardiac failure. We report a surgical case of a 40-year-old man, who had been diagnosed as prosthetic valve endocarditis with aortic root abscess ruptured into left and right ventricle creating aorto-left and right ventricular communication. Because of complete debridment of infective and/or dead tissue, aortic root replacement was required. We used free-style stentless valve, xenograft, since homograft was not available at the time of operation. We believe that this prosthesis has easier handling and is more resistant to infection, therefore, it might be an option for infective endocarditis with aortic root abscess.     

Discrete membranous subaortic stenosis complicated by infective endocarditis: a case report

Discrete membraneous subaortic stenosis is an uncommon cause of left ventricular outflow tract obstruction. Although its relationship to infective endocarditis is well defined, the expected site of vegetation is over the aortic valve. We report on a 46-year-old man who had a discrete membranous subaortic stenosis, complicated with infective endocarditis, in which the vegetation was over the subaortic membrane and the aortic valve was spared. To our knowledge, this is the first reported case of that entity.