[Infectious mitroaortic endocarditis complicated by valve perforation, mycotic aneurysm and splenorenal infarction]. / Endocardite infectieuse mitro-aortique compliquée de perforation valvulaire, d'anévrisme mycotique et d'infarctus spleno-rénal.

Infectious endocarditis is regarded as a potentially serious pathology despite the advances in diagnostic and treatment options. Valves on the left side of the heart are most affected and embolic events, mycotic aneurysms, abscesses as well as valve perforations are life-threatening consequences of this disease. We here report a case of endocarditis with aortic and mitral valve involvement complicated by splenic and renal infarction, cerebral mycotic aneurysm and mitral valve perforation. The interest in the subject of this case study is the positive medico-surgical treatment outcome obtained despite a multitude of complications.

The relationship between causative microorganisms and cardiac lesions caused by infective endocarditis: New perspectives from the contemporary cohort of patients.

BACKGROUND: The etiology of infective endocarditis (IE) is changing. More aggressive forms with multiple IE cardiac lesions have become more frequent. This study sought to explore the relationship between contemporary causative microorganisms and IE cardiac lesions and to analyze the impact of multiple lesions on treatment choice. METHODS: In 246 patients hospitalized for IE between 2008 and 2015, cardiac lesions caused by IE were analyzed by echocardiography, classified according to the 2015 European Society of Cardiology guidelines and correlated with microbiological data. We defined a new parameter, the Echo IE Sum, to summarize all IE cardiac lesions in a single patient, enabling comprehensive comparisons between different etiologies and treatment strategies. RESULTS: Staphylococcus aureus was associated with the development of large vegetation (OR 2.442; 95% CI 1.220-4.889; p=0.012), non-HACEK bacteria with large vegetation (OR 13.662; 95% CI 2.801-66.639; p=0.001), perivalvular abscess or perivalvular pseudoaneurysm (OR 5.283; 95% CI 1.069-26.096; p=0.041), and coagulase-negative staphylococci (CoNS) with leaflet abscess or aneurysm (OR 3.451; 95% CI 1.285-9.266, p=0.014), and perivalvular abscess or perivalvular pseudoaneurysm (OR 4.290; 95% CI 1.583-11.627; p=0.004). The Echo IE Sum significantly differed between different etiologies (p<0.001), with the highest value in non-HACEK and the lowest in streptococcal endocarditis. Patients operated for IE had a significantly higher Echo IE Sum vs those who were medically treated (p<0.001). CONCLUSION: None of the IE cardiac lesions is microorganism-specific. However, more severe lesions were caused by S. aureus, CoNS, and non-HACEK bacteria. The highest propensity to develop multiple lesions was shown by the non-HACEK group. Higher Echo IE Sum in patients sent to surgery emphasized the importance of multiple IE cardiac lesions on treatment choice and potential usage of Echo IE Sum in patient management.

[Mitral Valve Repair in a Patient with Two Aneurysms of the Mitral Valve Due to Infective Endocarditis;Report of a Case].

Echocardiography revealed 2 aneurysms in the mitral valve with mitral regurgitation and aortic regurgitation,in a 42-years-old man. He had had infective endocarditis due to Streptococcus 9 months before. A prolapse in the right coronary cusp without vegetation and 2 aneurysms in the anterior mitral leaflet were found intraoperatively. Aortic valve was replaced, and then mitral aneurysms were resected and repaired using his own pericardium. There has been almost no regurgitation or recurrence of infection over 3 years.

Pseudoaneurysm of the left ventricular outflow tract after cardiac surgery.

Pseudoaneurysms of the left ventricular outflow tract (LVOT) are rare entity. We present a case of false aneurysm caused by a chronic bacterial infection after mechanical aortic valve replacement in otherwise healthy and asymptomatic young man.

Infective Endocarditis of the Aortic Valve with Anterior Mitral Valve Leaflet Aneurysm.

Mitral valve leaflet aneurysm is a rare and potentially devastating complication of aortic valve endocarditis. We report the case of a 48-year-old man who had endocarditis of the native aortic valve and a concomitant aneurysm of the anterior mitral valve leaflet. Severe mitral regurgitation occurred after the aneurysm perforated. The patient showed no signs of heart failure and completed a 6-week regimen of antibiotic therapy before undergoing successful aortic and mitral valve replacement. In addition to the patient's case, we review the relevant medical literature.

Invasive Methicillin-Resistant Staphylococcus Aureus Endocarditis Resulting in Right Ventricular Pseudoaneurysm and Fistulation to Previous Bypass Graft.

We describe the case of a 73-year-old man with methicillin-resistant Staphyloccocus aureus (MRSA) endocarditis, which developed into a right ventricular pseudoaneurysm that fistulated into a previous saphenous vein graft to his distal right coronary artery (RCA). The patient was taken for a redo sternotomy, surgical evacuation of the abscess, bovine pericardial patch reconstruction of the right ventricular free wall, and tricuspid valve repair. Despite our best efforts and a repair that appeared sufficient at the time of operation, the patient died of ischemic colitis on postoperative day 5. This case report highlights some of the surgical considerations for such a rare and lethal condition.

Bacterial pancarditis with myocardial abscess: successful surgical intervention in a 14-month-old boy.

A 14-month-old boy with a structurally normal heart presented with signs of cardiac tamponade caused by purulent pericarditis. During his hospital stay, mitral and tricuspid valve endocarditis developed, and a ventricular septal abscess expanded despite appropriate, prolonged antibiotic therapy for methicillin-resistant Staphylococcus aureus. The day before scheduled surgical correction, the abscess ruptured, creating a septal aneurysm. Surgical intervention resulted in an excellent outcome. Throughout the patient's 67-day hospitalization, the use of echocardiography was crucial in monitoring and diagnosis. In addition to reporting this case, we discuss our diagnostic and treatment considerations. To our knowledge, this is only the 4th report of S. aureus bacterial pancarditis with myocardial abscess.

Unusual left ventricular pseudoaneurysm in a child after disseminated bacterial infection.

Left ventricular pseudoaneurysms are rare in children. A six-year-old boy developed left ventricular pseudoaneurysm despite successful control of sepsis. The pseudoaneurysm was diagnosed by two-dimensional echocardiography and detailed by computed tomography. The child underwent successful surgical correction with partial excision and plication of the aneurysmal sac.

Uncommon cause of left ventricular pseudoaneurysm: case report and review of literature.

We report a case of an 18-year-old man without tuberculosis history who presented with chest distress, dyspnea, and fever. Chest computed tomography scan and echocardiography showed left ventricular posterior wall pseudoaneurysm and perforation. Unfortunately, the patient died shortly after surgery. On the basis of surgical pathology, we made a final diagnosis of tuberculous pericarditis complicated with left ventricular pseudoaneurysm. This has not been reported before in the published literature.

Apical left ventricular false aneurysm after transapical transcatheter aortic valve implantation.

Transcatheter valve implantation (TAVI) is becoming a routine procedure to treat severe symptomatic aortic stenosis. It is associated with complications different from those of conventional aortic valve surgery. We describe an 80-year old man who developed an apical left ventricular (LV) false aneurysm 3 months after transapical TAVI (TA-TAVI) complicated postoperatively by a surgical site infection (SSI). Three months earlier, an Edwards Sapien bioprosthesis no. 29 had been successfully inserted transapically because of severe comorbidities and a very large aortic annulus. His postoperative course was complicated by acute respiratory failure, gastrointestinal bleeding and a surgical site infection of the thoracic incision; Escherichia coli and Klebsiella pneumonia were isolated. After surgical debridement drainage and prolonged antibiotic therapy, the wound healed correctly. His emergency chest computed tomography upon readmission for the acute onset of a beating tumefaction at the TA-TAVI site showed a false aneurysm of the LV apex. The apex was closed directly during emergency surgery. The postoperative course was uneventful. Surgical site infection after TA-TAVI, its frequency, treatment and potential role as an underlying cause of this severe complication are discussed.

Perivalvular pseudoaneurysm caused by streptococcus dysgalactiae in the presence of prosthetic aortic valve endocarditis.

A 62-year-old man with a medical history of aortic valve replacement was referred to our hospital with high-grade fever. Blood culture was positive for Streptococcus dysgalactiae, and the echocardiogram showed edematous aortic annulus, suggesting a perivalvular abscess. Treatment with antibiotics was started, which showed progressive improvement. The echocardiogram at 2 weeks after admission showed progression of the perivalvular abscess, resulting in the formation of a perivalvular pseudoaneruysm, which revealed rapid enlargement. The patient underwent surgical resection of a 20-mm pseudoaneurysm, originating from the right and left coronary cusp. Complete resection of the infective tissue was performed, and an aortic root replacement was done. This case highlights that a frequent follow-up should be performed in case of perivalvular abscess, because of the risk of pseudoaneurysm formation, which may cause a life-threatening outcome.

Multiple mycotic aneurysms reveal Staphylococcus lugdunensis endocarditis in a young patient.

Mycotic aneurysms are rare, and depending on their location, can threaten functional prognosis. We report on a 17-year-old girl with no previous history of cardiovascular or infectious disease, referred to our Department of Cardiology with right hemiplegia and aphasia. A neurological evaluation revealed thrombosis of a mycotic cerebral aneurysm, complicated by ischemic and hemorrhagic infarction. Transthoracic echocardiography indicated huge, highly mobile mitral vegetation associated with a mitral regurgitation with a triple stream. Hemocultures isolated Staphylococcus lugdunensis. Shortly afterward, she developed bilateral tibial and pedal mycotic aneurysm. The patient received antibiotics, with minor neurological improvement initially, but she soon died because of a brain herniation. Based on our findings in this case, we discuss the features of endocarditis attributable to S. lugdunensis.

Surgically treated infective endocarditis involving the aortic bicuspid valve and ventricular septum revealing aortic regurgitation and a Gerbode defect.

A 41-year-old man who had been previously diagnosed with bicuspid aortic valve presented to our hospital with repeating episodes of fever. Echocardiography revealed vegetation in the bicuspid valve as well as left-to-right shunt, making one suspicious of rupture of the sinus of Valsalva. Under the diagnosis of infective endocarditis of the aortic valve and rupture of the sinus of Valsalva, the patient underwent a surgical operation. Operative findings showed normal sinus of Valsalva; but a communication between the left ventricle and right atrium was present, suggesting a Gerbode defect. The patient was treated by autologous pericardial patch closure and aortic valve replacement and was dismissed from the hospital without major complications.

Medical treatment of a Salmonella-infected left ventricular pseudoaneurysm: a case report.

Here, we present a case of Salmonella infection in a post-myocardial infarction patient with a left ventricular aneurysm and mural thrombus. This is a rare case that was successfully treated with medicinal therapy alone. Our experience with this case documents the early spontaneous drainage of the myocardial abscess by 8 weeks of antibiotic therapy under serial two- and three-dimensional echocardiography to monitor the clinical outcomes and guide the decision-making process. This approach may be a viable alternative for intolerant, high-risk surgical aneurysmectomy patients.