Severe cardiogenic shock due to acute onset of an aorto-to-right atrial shunt in a patient with aortic valve endocarditis

INTRODUCTION

Heart failure is the most common cause of death due to infective endocarditis. We report a case of a patient presenting with severe shock due to an infection-associated left-to-right cardiac shunt.

PRESENTATION OF CASE

A 62-year-old man, who underwent aortic valve replacement five years previously, was admitted to ICU due to acute hemodynamic deterioration. A few days earlier, he had a septic episode with blood cultures positive for Staphylococcus aureus and clinical features of infective endocarditis. In ICU, transthoracic echocardiography revealed shunting from the aortic root to the right atrium resulting in severe cardiogenic shock.

DISCUSSION

This case report describes a near fatal complication of infective endocarditis, detected by routine use of transthoracic echocardiography.

CONCLUSION

Our case outlines the relevance of early cardiac surgery strategies in patients with infective endocarditis and we briefly discuss the current literature.     

Midterm outcomes after aortic valve neocuspidization with glutaraldehyde-treated autologous pericardium

Objective

We had previously reported the short-term results of the aortic valve neocuspidization (AVNeo) procedure. We have now evaluated the midterm results with the longest follow-up of 118 months.

Early and mid-term results of isolated aortic valve neocuspidization in patients with aortic stenosis

Objectives

This study aimed to elucidate the surgical outcome of aortic valve neocuspidization (AVNeo) in patients with aortic stenosis (AS).

Methods

From December 2010 to June 2017, we performed AVNeo for aortic valve pathologies in 144 patients. Of them, we evaluated 57 patients with AS who underwent AVNeo. Their mean age was 77.5?±?8.8 years. Fifty-five patients had AS from degenerative changes, 1 from pericardium endocarditis, and 1 from prosthetic valve endocarditis. Forty patients had a tricuspid aortic valve, 1 had a unicuspid valve, 14 had a bicuspid valve, 1 had a quadricuspid valve, and 1 had postoperative aortic valve replacement (AVR). Preoperative echocardiography revealed an average peak pressure gradient of 89?±?32.9 mmHg and a mean pressure gradient of 52?±?18.8 mmHg. The surgical procedure complies with the 3 cuspid suturing to the aortic annulus with the glutaraldehyde-treated pericardium.

Results

There were no conversions to AVR. There were 2 noncardiac-related deaths owing to liver failure and sepsis. Postoperative echocardiography showed an average peak pressure gradient of 22?±?10.7 mmHg 1 week after the procedure and 19.2?±?9.7 mmHg 20 months after the procedure. Two patients underwent reoperation owing to infective endocarditis and recurrent aortic regurgitation. The mean follow-up period was 30.4?±?20.8 months. The freedom from reoperation rates was 98.1 and 95.3% at 12 and 81 months of follow-up, respectively.

Conclusions

AVNeo is suitable for patients with AS considering its early and mid-term outcomes. Verification of long-term outcomes and reliability is necessary.

     

Infective endocarditis at the tricuspid valve following central venous catheterization

We report a case of infective endocarditis at the tricuspid valve attributed to central venous catheterization. The patient was a 35-year-old woman who had multiple septic emboli in her lung due to tricuspid valve endocarditis after successful treatment of bronchiolitis obliterans organizing pneumonia. She also had right ileosacral arthritis. The case was closely related to catheter-associated Staphylococcus aureus bacteremia. She was treated with intravenous administration of vancomycin and surgical removal of vegetation and tricuspid valvuloplasty. Since infective endocarditis can be a complication of central venous catheterization with high morbidity and mortality, maximal precautions to minimize the risk, early detection, and appropriate treatment of these complications are mandatory to improve patients outcome.     

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.     

Redo cardiac surgery for active prosthetic valve endocarditis associated with hereditary hemorrhagic telangiectasia: report of a case

Hereditary hemorrhagic telangiectasia (HHT) is caused by an autosomal dominant gene and characterized by multiple arteriovenous malformations in several organs, leading to bleeding or shunting. These patients often suffer severe infections and heart failure, which should be managed in the perioperative period, when open heart surgery is indicated. We report a case of successful aortic root replacement for active prosthetic valve endocarditis and ventricular septal perforation in a patient with HHT, who had severe heart failure.     

Aortic Valve Myxoma Mimicking Vegetation: Report of a Case

We report a case of cardiac myxoma of the aortic valve. To our knowledge, this represents only the seventh such case ever documented. A 61-year-old woman underwent an echocardiography to screen for hypertensive–diabetic cardiac complications, which showed a mass on her aortic valve. Although she had not experienced a fever, the mass closely resembled a vegetation, resulting in an initial diagnosis of infective endocarditis. We extirpated the mass and repaired the aortic valve with the patient under cardiopulmonary bypass. The postoperative course was uneventful. Histological examination confirmed that the mass was a myxoma.     

Aortic valve replacement in an elderly patient with factor XI deficiency

Factor XI (FXI) deficiency is rare and associated with bleeding after surgical procedures. We report a case of an 80-year-old woman with severe aortic valve stenosis. FXI deficiency was diagnosed due to prolonged activated partial thromboplastin time. Aortic valve replacement was performed using a porcine bioprosthetic valve. Intra-operation bleeding was controlled by the transfusion of a fresh frozen plasma. The postoperative course was uneventful.     

Surgical treatment of right-sided infective endocarditis

Objective

Right-sided infective endocarditis is increasing because of increasing prevalence of predisposing conditions, and the role and outcomes of surgery are unclear. We therefore investigated the surgical outcomes for right-sided infective endocarditis.

Aortic homograft implantation after Ozaki procedure: Case report

Introduction and importanceThe infective endocarditis incidence data for patients undergoing aortic valve neocuspidization with glutaraldehyde-treated autologous pericardium (Ozaki procedure) are rare, and the optimal surgical treatment strategy remains unclear.Case presentationThis is the first case report of surgical treatment of infective endocarditis of aortic valve with cryopreserved homograft in an athlete with previously performed Ozaki procedure.Clinical discussionThe choice of homograft was dictated by the young age of the patient; professional activity as an athlete; refusal of anticoagulants and the need for wide excision of compromised tissues to mitigate potential risk of spread of infection as well as its recurrence.ConclusionThe use of the aortic homograft allowed us to radically remove the infected tissues and achieve hemodynamic characteristics similar to the native valve. This is probably the first case report of use of homograft to treat aortic valve endocarditis following Ozaki procedure.     

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.     

A cardiac calcified amorphous tumor stuck in the aortic valve that mimicked a chameleon’s tongue: report of a case

A calcified amorphous tumor (CAT) is a rare intracardiac mass that carries a risk of embolism. We herein present the case of a club-shaped CAT that originated from the calcified mitral annulus. Echocardiography indicated a pendular motion of the mass and repeated entrapment by a stenotic aortic valve that was sustained for several beats, mimicking a chameleon’s tongue. An emergency operation was performed because of the risk of embolism, as well as potential progression of cardiac failure due to worsening aortic valve stenosis. The histological findings were consistent with the diagnosis of a CAT. This report describes a case of an intracardiac tumor that showed unique motion like a chameleon’s tongue.     

Early surgery for active infective endocarditis.

OBJECTIVE: The timing of surgery for active infective endocarditis remains controversial. In this report, we have reviewed 26 patients who underwent surgery for active infective native-valve endocarditis between April 1992 and December 1998. PATIENTS AND METHOD: There were 19 male and 7 female patients (mean age 45 years). The aortic valve was involved in 8 patients, the mitral valve in 6 patients, tricuspid valve in 2 patients, both aortic and mitral valves in 7 patients, both aortic and tricuspid valve in 2 patients, and both mitral and tricuspid valve in one patient. The most common microorganisms were streptococcal species. Preoperative high New York Heart Association functional class (III and IV) was presented in 20 patients (77%). Progressive heart failure and the echocardiographic findings of vegetation (larger than 1 cm) were the main operative indications. Emergency or urgent surgery was required in 18 patients (70%). All patients underwent valve replacement, involving 25 mechanical prosthesis and 8 bioprosthesis. RESULTS: The operative mortality was 7.8% (n = 2). In the two patients who died, the infection had extended to the deep cardiac tissue and to the cerebral artery. The mean follow-up of the 24 survivors was 33 months (range from 6 to 82 months). There was no late death and no recurrence of infective endocarditis. CONCLUSION: In case of active infective endocarditis, early surgical intervention is recommended in patients with rapidly progressive cardiac deterioration or vegetation seen on echocardiography.     

Similar improvement of left ventricular performance after valve replacement for aortic stenosis with small aortic annuli among three different implantation techniques

Background

We evaluated the effects of three implantation techniques (everting mattress, non-everting mattress, and simple interrupt techniques) for aortic valve replacement in severe aortic stenosis with small aortic annulus on left ventricular performance and function.

Methods

Eighty-five patients who underwent aortic valve replacement for severe aortic valve stenosis were retrospectively examined. Left ventricular mechanics (Ees, end-systolic elastance; Ea, effective arterial elastance and efficiency), left ventricular ejection fraction, effective orifice area index, peak aortic valve velocity, and the left ventricular mass index were measured before and up to 1 month after surgery. Two-way repeated measure analysis of variance was used to compare parameters among the three valve replacement techniques.

Results

Echocardiography after aortic valve replacement showed similar significant increases in the effective orifice area index (p?p?p?p?=?0.80), and Ea decreased significantly and similarly in each group after surgery (p?p?p?Conclusions The three implantation techniques for aortic valve replacement gave equally satisfactory hemodynamic results and any would be reliable for patients with severe aortic valve stenosis and small aortic annuli.     

Septicémie à pneumocoque révélée par une arthrite septique et un pseudosyndrome d’Austrian par atteinte des valves tricuspides chez un patient infecté par le VIH

Invasive pneumococcal infection (IPI) is a re-emerging complication of Streptococcus pneumoniae infection, particularly in patients with human immunodeficiency virus (VIH) infection. We report a case of a patient who presented with pneumococcal septicaemia, meningitis and septic arthritis, which initially responded to antibiotics, but where the patient eventually succumbed to infective endocarditis of the tricuspid valve. We discuss the spectrum of clinical manifestations of IPI, focusing especially on the Austrian syndrome (defined as pneumococcal endocarditis with rupture of the aortic valve and meningitis), its association with VIH infection, and its management in light of the emergence of penicillin-resistant strains of S. pneumonia.     

Reimplantation of the aortic valve at 20 years

Objective

To provide additional information on clinical and echocardiographic outcomes after reimplantation of the aortic valve (RAV) in patients with aortic root aneurysm.

Mesenteric pseudoaneurysm and cerebral stroke as sequelae of infective endocarditis in an adolescent

Infective endocarditis is uncommon in children, and there is a paucity of literature concerning cases that involve unique or resistant organisms. Complications associated with infective endocarditis are distinctly rare and poorly characterized, especially unusual sequelae such as pseudoaneuryms of the abdominal mesentery. Our case involves an adolescent who presented with several weeks of fever and eventual cardiac murmur and was found to have vancomycin-resistant Enterococcus growing as a vegetation on a previously undiagnosed bicuspid aortic valve. He had a cerebral stroke presenting as Broca's aphasia before cardiac surgery, as well as a superior mesenteric artery pseudoaneurysm several days postoperatively. The case highlights some of the serious surgical complications that can occur in young persons with infective endocarditis, as well as many of the problems involved in managing a patient with highly resistant pathogens and a surgically challenging location of the aneurysm.     

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.     

A case of minimal invasive aortic valve replacement for quadricuspid aortic valve with aortic regurgitation]

Congenital quadricuspid aortic valve is rare, which may be a cause of sever aortic regurgitation. We report a case of a 55-year-old man who had severe aortic regurgitation with congenital quadricuspid aortic valve. Preoperative aortography showed severe aortic regurgitation. Preoperative trans-esophageal echocardiography revealed abnormal quadricuspid aortic valve. We performed minimal invasive aortic valve replacement with SJM # 21 mm HP prosthetic valve through the limited upper sternotomy. Skin incision was 9 cm. Aortic cross-clamping time was 92 min, cardiopulmonary bypass time was 108 min. At the operation, a quadricuspid valve with three equal cusps and one small cusp was noted. The postoperative course was excellent and he discharged 8 days after the operation.     

Impact of aortic root repair or replacement in severe destructive aortic valve endocarditis with paravalvular abscesses on long-term survival

 Open in a separate windowOBJECTIVESSurgical treatment of destructive infective endocarditis consists of extensive debridement followed by root repair or replacement. However, it remains unknown whether 1 is superior to the other. We aimed to analyse whether long-term results were better after root repair or replacement in patients with root endocarditis.METHODSA total of 148 consecutive patients with root endocarditis treated with surgery from 1997 to 2020 at our department were included. Patients were divided into 2 groups: aortic root repair (n = 85) or root replacement using xenografts or homografts (n = 63).RESULTSPatients receiving aortic root repair showed significantly better long-term survival compared to patients receiving aortic root replacement (log-rank: P = 0.037). There was no difference in terms of freedom from valvular reoperations among both treatment groups (log-rank: P = 0.58). Patients with aortic root repair showed higher freedom from recurrent endocarditis compared to patients with aortic root replacement (log-rank: P = 0.022). Patients with aortic root repair exhibited higher event-free survival (defined as a combination end point of freedom from death, valvular reoperation or recurrent endocarditis) compared to patients receiving aortic root replacement (log-rank: P = 0.022). Age increased the risk of mortality with 1.7% per year. Multi-variable adjusted statistical analysis revealed improved long-term event-free survival after aortic root repair (hazards ratio: 0.57, 95% confidence interval: 0.39–0.95; P = 0.031).CONCLUSIONSAortic root repair and replacement are feasible options for the surgical treatment of root endocarditis and are complementary methods, depending on the extent of infection. Patients with less advanced infection have a more favourable prognosis.Clinical trial registrationUN4232 382/3.1 (retrospective study).