“Double‐barrel endocarditis”

We report a case of an 18‐year‐old woman who presented with infective endocarditis (IE), in two conduits percutaneously delivered in the right ventricle outflow tract (“double‐barrel endocarditis”). The patient's clinical presentation, echocardiogram findings, infectious agent, clinical management, surgical approach, and follow‐up assessment are described. Percutaneous pulmonary valve implantation has emerged as a viable therapy for conduit dysfunction in the right ventricular outflow tract. Although the percutaneous approach has several advantages, this strategy and the valves used are not complication‐free. IE after transcatheter valve deployment has evoked the growing concern, as there is a higher incidence in these patients compared with patients with surgically repaired pulmonary valves. As a result, this type of surgical treatment is especially important.     

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.     

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.     

Prosthetic Valve Endocarditis Caused by Metallo-β-Lactamase-Producing Pseudomonas Aeruginosa

Abstract   Prosthetic valve endocarditis (PVE) caused by Pseudomonas aeruginosa is a rare but life-threatening complication. Early surgical intervention, as well as appropriate antimicrobial therapy, is usually necessary. Recently, problems have arisen regarding infection with P. aeruginosa , which produces metallo-β-lactamase (MBL) and is resistant to virtually all β-lactams. This organism has rapidly spread through many countries. Here, we report the first case of successful redo aortic valve replacement using a Prima Plus stentless valve (Edwards Lifesciences, Irvine, CA, USA) followed by a 6-week course of ciprofloxacin and gentamicin for early PVE caused by MBL-producing P. aeruginosa .     

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.     

Brucella endocarditis with repeated mitral valve replacement

Brucella endocarditis, although a rare complication of brucellosis, is a life threatening and often under-diagnosed complication. Despite its high mortality rate with combined medical and surgical treatment, has a low occurrence rate in cases of brucellosis. Here we describe a patient who underwent mitral valve replacement for 3 times due to underdiagnosis of Brucella endocarditis. If a valve replacement fails because of an unknown reason, the doubt of a Brucella infection should be kept in mind for accurate treatment of such patients.     

Percutaneous mitral valve repair in patients with prior cardiac surgery

Abstract Background and aim of the study: The safety of percutaneous mitral valve repair with the MitraClip system has been documented. However, few data are available on high‐risk patients not amenable to surgery. The aim of this study was to evaluate the outcomes of patients with prior cardiac surgery undergoing MitraClip therapy (Abbott, Abbott Park, Chicago, IL, USA) for severe mitral regurgitation. Methods: We reported two cases of percutaneous treatment of severe mitral regurgitation performed in patients who had previously undergone cardiac surgery with the implantation of mechanical prosthetic aortic valve. Results: In both the reported cases a sustained reduction in mitral regurgitation severity was obtained at two‐year follow‐up, with a relevant improvement in terms of clinical status and quality of life. Conclusions: Percutaneous mitral valve repair using the MitraClip system represents a viable treatment choice for severe mitral regurgitation in high‐risk patients who have previously undergone cardiac surgery. (J Card Surg 2012;27:295‐298)     

Widerspread septic peripheral emboli from acute Enterococcus faecalis aortic valve endocarditis in a 39-year-old patient, drug addict

Enterococci have emerged in the last decades as a major cause of nosocomial or common infections and Enterococcus faecalis is responsable for 80% of all enterococcal infection. Actually, E. faecalis is the third-most-common cause of bacterial endocarditis overall and predisposing risk factors are the existence of a prosthetic valve, the age, or a previous endocarditis. Among the complications of infective endocarditis, systemic emboli are an ominous prognostic sign. Infective endocarditis still carries high morbidity and mortality rates for the patients requiring intensive care unit admission. The choice and optimal timing depend on many factors like the tolerance of the underlying cardiac disease. Indications for urgent surgical intervention are heart failure, systemic emboli, and uncontrolled sepsis despite a first adequate antibiotic therapy associating aminopenicilline and gentamicine. We report the case of a 39-year-old patient, drug-addict, admitted to the emergency department due a respiratory insuffiency, acute abdominal pain and left brachiofacial palsy and who presented a acute native aortic valve endocarditis with renal, splenic and cerebral emboli and required an urgent mechanical valvular prosthese implantation associating to a right colostomy.     

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.     

Ventricular septal fistula formation due to infectious endocarditis in a hemodialysis patient with aortic valve replacement

We report a case of infectious endocarditis in a 77-year-old woman who was undergoing maintenance hemodialysis therapy, and who was also having a prosthetic aortic valve replacement. The disease resulted from a local skin infection at the needle puncture site of the arteriovenous fistula. Ampicillin-resistant Staphylococcus aureus was the causal organism. Surgical treatment could not be performed because of associated intracranial hemorrhage due to septic embolism. In spite of intensive treatment with several antibiotics, a ventricular septal abscess just beneath the prosthetic aortic valve progressed to form a ventricular septal fistula. The resultant intracardiac left-to-right shunt led to refractory congestive heart failure. The patient finally died of heart failure. The formation of a ventricular septal fistula is considered to be a rare and extraordinary complication of infectious endocarditis in a hemodialysis patient with aortic valve replacement. Received: July 25, 2001 / Accepted: November 3, 2001     

Surgical treatment of infective valve endocarditis in children with congenital heart disease

Abstract Objective: This study assesses surgical procedures, operative outcome, and early and intermediate‐term results of infective valve endocarditis in children with congenital heart disease. Methods: Seven consecutive children (five females, two males; mean age, 10.8 years) who underwent surgery for infective valve endocarditis between 2006 and 2010 were included in the study. The aortic and mitral valves were affected in two and tricuspid in five patients. Indications for operation included cardiac failure due to atrioventricular septal rupture, severe tricuspid valve insufficiency, and septic embolization in one, moderate valvular dysfunction with vegetations in three (two tricuspid, one mitral), and severe valvular dysfunction with vegetations in the other three patients (two tricuspid, one mitral). The pathological microorganism was identified in five patients. Tricuspid valve repair was performed with ventricular septal defect (VSD) closure in five patients. Two patients required mitral valve repair including one with additional aortic valve replacement. Results: There were no operative deaths. Actuarial freedom from recurrent infection at one and three years was 100%. Early echocardiographic follow‐up showed four patients to have mild atrioventricular valve regurgitation (three tricuspid and one mitral) and three had no valvular regurgitation. No leakage from the VSD closure or any valvular stenosis was detected postoperatively. Conclusions: Mitral and tricuspid valve repairs can be performed with low morbidity/mortality rates and satisfactory intermediate‐term results in children with infective valve endocarditis . (J Card Surg 2012;27:93‐98)     

Transaortic Mitral Valve Repair in Double Valve Infective Endocarditis

Abstract We present a case of a transaortic mitral valve repair in double valve infective endocarditis. Through a conventional oblique aortotomy, the aneurysmal part of the anterior leaflet of the mitral valve was excised, an artificial neo chorda was implanted, and the aortic valve was replaced. (J Card Surg 2010;25:651‐653)     

Rupture of Aortic Pseudoaneursym Arising from a Transverse Aortotomy Line 12 Years Following Mechanical Aortic Valve Replacement

Abstract Pseudoaneurysm formation at the site of aortotomy is a rare complication following aortic valve replacement; it appears to be more common in those whose valve is replaced for endocarditis or in those who develop an early postoperative endocarditis or sepsis. We discuss the case of a 77‐year‐old male, who presented 12 years following mechanical aortic valve replacement, with rupture of an ascending aortic pseudoaneurysm arising from a transverse aortotomy line. (J Card Surg 2010;25:563‐565)     

A case report of early prosthetic valve endocarditis due to methicillin resistant Staphylococcus aureus infection--an experience of intraatrial implantation of mitral prosthesis with a Gore-Tex flange

A 60-year-old female with mitral stenosis developed prosthetic valve endocarditis due to methicillin resistant staphylococcus aureus septicemia 3 weeks after mitral valve replacement. In vitro test disclosed susceptibility to minocycline and clindamycin. Despite large amount of intravenous administration, progressive heart failure due to massive perivalvular leakage occurred as a consequence of persisting infection. An emergent operation revealed valve detachment of the posterior portion resulting from ring abscess formation. A mitral prosthesis with a Gore-Tex flange was implanted partially in the left atrium just above the mitral ring and sutured to the atrial wall. Postoperative relapse was not detected even after discontinuing antibiotics. Prosthetic valve endocarditis due to methicillin resistant staphylococcus aureus is highly resistant to antibiotic therapy and likely to develop valve ring abscess. Prompt surgical treatment is mandatory in this situation.     

Surgical treatment of an <Emphasis Type="Italic">Echinococcus</Emphasis> cyst of the interventricular septum complicated by septic endocarditis,complete atrioventricular block,and rupture into the Valsalva sinus

A 40-year-old man was emergently hospitalized because of high fever, a transient ischemic attack, and complete atrioventricular block. The diagnosis was endocarditis, cyst of the interventricular septum (IVS), and complete atrioventricular block. A temporary pacemaker was introduced, and the patient underwent surgery that included IVS cystectomy, ventricular septum plication, and aortic valve replacement. A permanent pacemaker was implanted during the early postoperative period. The patient was discharged from the medical center on day 9 after primary surgery. At the 4-month postoperative follow-up, the patient was found to be in normal condition. Patients with high temperature, heart rhythm and conduction disorders, and dyspnea of unknown etiology might be harboring Echinococcus despite the absence of primary liver or lung damage. Urgent surgical treatment is necessary even on suspicion of complicated hydatid damage to the heart.     

Aspergillus endocarditis in a native valve without prior cardiac surgery

Aspergillus native valve endocarditis continues to be a lethal disease, even when maximal therapeutic options are taken. We describe herein a patient with mitral valve endocarditis due to Aspergillus fumigatus following colon cancer and invasive pulmonary aspergillosis. Voriconazole was effective in controlling pulmonary and cerebral aspergillosis, despite the relative ineffectiveness for the vegetation. With the combination of aggressive medical and surgical therapy, the patient survived and remains without any evidence of infection 2?years later.     

When and how does nonstructural mechanical prosthetic heart valve dysfunction occur?

Objective: We diseuss the clinical aspects related to mechanical valve dysfunction based upon 20 years' experience of our cases.Methods: Between January 1982 and December 2001, 21 patients underwent surgical interventions because of mechanical valve dysfunction. Thirteen men and 8 women (mean age 47±20, range 3–75 years-old), were included.Results: Mitral valve dysfunction was observed in 12 patients. Prosthetic valve stenosis occurred in 6 patients between 2 and 224 months, and paravalvular leaks in 4 between 1 and 71 months after surgery. The other 2 patients suffered from hemolytic anemia with mild paravalvular leaks between 102 and 104 months after surgery. Aortic valve dysfunction was observed in 8 patients including 3 stenotic lesions between 48 and 97 months and 5 paravalvular leaks between 3 and 150 months after surgery. Tricuspid regurgitation was seen in 1 patient with a huge right atrium at 42 months after surgery. Early death was seen in 1 patient. Late death occurred in 1 patient, 17 years after operation. Survival, including early death, was 95.2% at 10 and 15 years. One valve-related complication of bioprosthetic valve endocarditis at the mitral and tricuspid positions occurred 12 years after a reoperation. The freedom from complications was 95.2% at 10 years, and 76.2% at 15 years.Conclusions: Paravalvular leaks without overt endocarditis had latency periods of up to 12 years, and pannus formation was observed 20 years after surgery. Early and late clincal results after surgery for mechanical valve dysfunction were excellent.     

Stentless Xenograft Repair of Excavating Aortic Root Sepsis

BACKGROUND: A variety of surgical techniques are used to manage a disintegrated aortic annulus in patients with endocarditis and excavating aortic root sepsis. Homograft root replacement is preferable in this setting but suitable homografts are restricted in availability and excision of the aortic root carries the risk of postoperative bleeding. As an alternative we used a stentless porcine xenograft root (Medtronic Freestyle valve) to manage this problem. METHODS: Three male patients with active endocarditis presented with aortic root abscess and partial or complete aorto-left ventricular discontinuity. One had prosthetic valve endocarditis, and the abscess cavity entered the right atrium in another. The porcine aortic root was successfully implanted using the modified subcoronary technique providing a repair within the aortic root with proximal and distal suture lines that excluded the disintegrating tissues from the blood stream. All patients were treated with intravenous antibiotics for 6 weeks postoperatively and none suffered recurrent infection (follow-up > 6 months). CONCLUSION: The stentless porcine aortic root implanted within the human aorta provides an additional surgical option for excavating aortic root sepsis.     

Brucella glomerulonephritis and prosthetic valve endocarditis: a case report

Although brucellosis is an endemic disease in Mediterranean countries, there are few reported cases of Brucella endocarditis and glomerulonephritis. We report a case of Brucella prosthetic mitral valve endocarditis and glomerulonephritis that could be managed by using only antibiotic therapy, including rifampicin, doxycycline and ceftriaxone, without a surgical procedure.     

Splenic abscess associated with active infective endocarditis

Splenic abscess is a rare complication in infective endocarditis. Here, we present two cases of splenic abscess associated with active infective endocarditis. Body computed tomography before emergency valvular surgery revealed abscess in the spleen. In case 1, the abscess was localized within the spleen; splenectomy and valve replacement were performed through the same median skin incision. In case 2, the splenic abscess was diagnosed as ruptured; valve replacement was performed, followed by splenectomy through a separate skin incision. No recurrence of infection occurred after surgery in either case. In surgical treatment for active infective endocarditis, body computed tomography is essential to diagnose splenic abscess preoperatively. If there is an abscess, then splenectomy and valvular surgery should be performed simultaneously to prevent reinfection after valvular surgery. The approach to the spleen should be individualized according to the extension of the abscess.