A rare simultaneous occurrence: Mitral valve endocarditis complicated by iliac saddle and cerebral embolisms / Un incidente simultáneo inusual: endocarditis de la válvula mitral complicada por embolia ilíaca en silla de montar y embolia cerebral

Abstract Infective endocarditis is a severe disease with a high mortality and morbidity, and its clinical heterogeneity is a challenging barrier to rapid diagnosis and treatment. Diagnosis of infective endocarditis is based on clinical, microbiological, and echocardiographic findings; however, a high index of suspicion is mandatory because this disease may present either as an acute, rapidly progressive infection or as a chronic disease. Approximately 20-50% of cases show multiple embolic events as the first presentation of infective endocarditis. We report a patient with a rare case of infective endocarditis complicated with iliac saddle and cerebral embolisms who underwent simultaneous operations for mitral valve endocarditis and iliac embolism.

Resumen La endocarditis infecciosa es una enfermedad grave, que conlleva alta morbimortalidad; su heterogeneidad clínica constituye una barrera desafiante para un rápido diagnóstico y tratamiento. El diagnóstico se basa en hallazgos clínicos, microbiológicos y ecocardiográficos; sin embargo, se requiere un alto índice de sospecha ya que esta enfermedad puede debutar ya sea como una infección aguda de rápida evolución o como una enfermedad crónica. Aproximadamente, 20 a 50% de los casos presentan múltiples eventos embólicos como primera manifestación de la endocarditis infecciosa. Se informa de un paciente con un caso inusual de endocarditis infecciosa complicada por embolia ilíaca en silla de montar y embolia cerebral, quien fue sometido a cirugías simultáneas por endocarditis de la válvula mitral y embolia ilíaca.

Embolia cerebral como presentación atípica de síndrome de May Thurner

El síndrome de May-Thurner es una anormalidad anatómica que consiste en la comprensión cronica de la vena iliaca común izquierda, entre la arteria ilíaca común derecha y la columna vertebral, que puede predisponer a la trombosis venosa profunda. Es una entidad rara, y es infrecuente que provoque una embolia paradojal cerebral. Se presenta el caso de una isquemia cerebral de origen embólico, en un varón de 30 años, luego de actividad sexual. Los estudios realizados revelaron síndrome de May-Thurner asociado con un foramen oval permeable y una trombofilia por factor V de Leiden. Fue tratado con anticoagulantes orales y no ha presentado recurrencias.

May-Thurner syndrome is an anatomic abnormality that predisposes patients to increase risk of paradoxical embolism and stroke. It consists of chronic compression of the left common iliac vein by the overlying right common iliac artery and lumbar spine. This may lead to deep venous thrombosis and paradoxical embolism that could provoke cerebral ischemia in patients with a cardiac shunt from right-to-left. Embolic cerebral ischemic event is reported in a 30-year-old man after sexual intercourse. Further studies revea led suggestive findings of May-Thurner syndrome coupled with a patent foramen ovale and a factor V Leiden thrombophilia. He was placed on anticoagulation therapy and has not had any recurrent events.

Endocarditis infecciosa fatal por Corynebacterium pseudodiphtheriticum / Letal endocarditis due to Corynebacterium pseudodiphtheriticum

We present a case report of a infective endocarditis by Corynebacterium pseudodiphtheriticum in a young patient eight years old with bicuspid aortic valve that led to a severe neurological embolism and death. Corynebacterium pseudodiphtheriticum is part of the nasopharyngeal and skin flora. However, there are cases reported of endocarditis usually associated with immunocompromised patients that mostly presented a poor clinical outcome.

Se presenta el caso clínico de una endocarditis infecciosa por Corynebacterium pseudodiphtheriticum en un niño de 8 años, portador de una valvulopatía aórtica bicúspide, que falleció por una embolia cerebral grave. Corynebacterium pseudodiphtheriticum forma parte de la microbiota de la piel y nasofaringe. Sin embargo, se han descrito casos de endocarditis en pacientes inmunocomprometidos, asociados, en su mayoría, a una mala evolución clínica.

Derrame isquêmico como a primeira manifestação de hipertrabeculação/não-compactação ventricular grave / Ischemic stroke as the first manifestation of severe ventricular hypertrabeculation/non-compaction

Um raro defeito congênito do miocárdio, conhecido como hipertrabeculação/não-compactação do ventrículo esquerdo (HTVE/NCVE) tem sido ocasionalmente descrito em associação com a formação de trombos com um potencial risco embólico sistêmico, mas sua associação com derrames isquêmicos permanece controversa. Reportamos o caso de um derrame isquêmico em paciente com grave (HTVE/NCVE) e disfunção ventricular como uma possível associação sinérgica etiológica. Na ausência de outras fontes embólicas, uma grave HTVE/NCVE associada com disfunção ventricular poderia constituir uma fonte potencial de embolismo cerebral, especialmente em pacientes com alta suspeita de um mecanismo embólico de derrame sistêmico.

A rare congenital myocardial defect, known as left ventricular hypertrabeculation/non-compaction (LVHT), has been occasionally described associated with thrombus formation with a potential systemic embolic risk, but its association with ischemic strokes remains controversial. We report a case of ischemic stroke in a patient with severe LVHT and ventricular dysfunction as a possible etiologic synergistic association. In absence of other embolic sources, a severe LVTH associated with ventricular dysfunction could constitute a potential source of brain embolism, especially in patients with high suspicion of an embolic mechanism of ischemic stroke.