Infectious endarteritis in aortic coarctation: two spectra of an infrequent disease.

OBJECTIVE: To describe two different degrees of clinical commitment and results in the evolution of infectious endarteritis in patients without a previous diagnosis of aortic coarctation. CASE DESCRIPTION: Two male patients aged 13 and 9 years old were admitted. The first due to a fever for 2 months, which started after dental cleaning, and the second due to high blood pressure, both patients with asthenia and weight loss. In the first case, the transthoracic echocardiogram showed aortic coarctation, and the transesophageal echocardiogram showed the presence of vegetations in the post-coarctation area, without pseudoaneurysms, with blood culture positive for Streptococcus mitis. This patient was treated for six weeks with crystalline penicillin, resolving the infection without complications. The second case was assessed for high blood pressure with a history of fever, and was treated with antibiotics. When performing a transthoracic echocardiogram, aortic coarctation was observed with a saccular image classified as a pseudoaneurysm by angiography and tomography. Blood culture was negative, and the patient developed an episode of hematemesis whose initial etiology could not be determined. Before surgical repair, he had a second episode of copious hematemesis with hypovolemic shock and death. COMMENTS: We need to have a high index of clinical suspicion to establish the diagnosis of aortic coarctation complicated by endarteritis and start the appropriate antibiotic treatment, always maintaining surveillance for the early detection of pseudoaneurysms.

Echocardiographic findings in patent ductus arteriosus-associated infective endarteritis.

BACKGROUND: Infectious endarteritis associated with patent ductus arteriosus (PDA-IE) is an uncommon complication in the era of antibiotics. However, it implies a clinical challenge in patients with a fever of undetermined origin; Two-dimensional transthoracic echocardiography (TTE) performs a fundamental role in diagnosis and follow-up. METHODS: A retrospective analysis was then made of the data of all patients admitted at our center with PDA-IE within 15 years, and a review of the literature regarding diagnosis, TTE findings, and treatment was performed. RESULTS: A total of 17 patients were identified. The mean age was 17.8 years. The TTE done in all patients confirmed the PDA and PA vegetations diagnosis; in five cases, one vegetation was present; in three cases, two vegetations were found, and in the nine remaining cases, three or more vegetations were observed. In two-thirds of the cases, the vegetations' size was 3 to 28 mm, and the principal morphology was filiform. In all cases, at least one of the vegetations was developed in the DA's lateral wall. Pulmonary valve (PV) was affected in 41% of the patients and caused low to moderate valvular regurgitation. Pulmonary embolism was present in 7 cases and pulmonary aneurism in one case. CONCLUSIONS: Decreased incidence of PDA-IE has been currently achieved with early antibiotic therapy. However, today, this complication carries a significant risk of valve damage and other cardiac structures' involvement.

Persistence of pulmonary endarteritis in canine heartworm infection 10 months after the eradication of adult parasites of Dirofilaria immitis.

Pulmonary endarteritis caused by Dirofilaria immitis and pulmonary hypertension (PH) are closely linked and the determination of PH could be validated to assess the severity and chronicity of the vascular damage, i.e. by the use of the Right Pulmonary Artery Distensibility (RPAD) Index. The aim was to evaluate the RPAD Index in dogs 10 months after the last dose of adulticide. The study included 23 client-owned dogs with heartworm brought for adulticide treatment. Echocardiographic exam was carried out to estimate worm burden, RPAD Index as well as other routine echocardiographic values on day 0 (diagnosis), day 120 (discharge), and 10 months after the last dose of adulticide. No significant differences were observed in the RPAD Index over time, neither when microfilaremic status and parasite burden were evaluated. An RPAD Index <29% was found in 52.2% of the dogs on day 0, day 120, and 10 months after the last dose of adulticide. Regarding other echocardiographic parameters, only significant differences were observed on tricuspid annular plane systolic excursion (TAPSE) values between day 0:day 120 (p = 0.008), and day 0:end of the study (p = 0.037). There was not significant improvement in pulmonary damage 10 months after the elimination of the parasites (p = 0.296), suggesting that, once the endarteritis has developed, the vascular changes are chronic and may not be reversible. The modifications of the TAPSE value suggest an improvement in the systolic function of the right ventricle after the disappearance of the worms, independently of the presence of PH. The endarteritis causes a decrease in the elasticity in the pulmonary vasculature and an increase in the resistance that, chronically, and depending on the severity, will cause the development of PH and later right heart failure. This complication of the disease is one of the most damaging and frequent, so it is necessary to adequately monitor PH in dogs undergoing adulticide treatment. Furthermore, knowing the pulmonary status could provide valuable information to help provide an objective prognosis and help assess the need to add additional treatments, once the worms have been eliminated.

Fungal prosthetic aortic valve endocarditis and endarteritis: An unusual cause of aortic root vegetations.

Fungal endocarditis is a relatively rare occurrence with high morbidity and mortality. Patients may have an indolent and non-specific course requiring a high index of suspicion to make a diagnosis. Here, we present the case of a 33-year-old patient who presented with fevers and acute lower limb ischemia requiring a 4-compartment fasciotomy caused by septic emboli from Candida albicans endocarditis. The patient had a large vegetation in the ascending aorta associated with a mycotic aneurysm, which is an exceedingly rare location for a vegetation. We also review the literature and summarize the typical echocardiographic appearance and vegetation locations in fungal endocarditis.

Cutaneous Arteriolosclerosis Is Not Specific to Ischemic Hypertensive Leg Ulcers.

BACKGROUND: The histological characteristic of hypertensive leg ulcers (HLU) is the presence of "arteriolosclerosis." The pertinence of performing a skin biopsy to diagnose HLU is questionable, as cutaneous arteriolosclerosis may be related to patient comorbidities. The objective here was to evaluate the frequency of arteriolosclerosis in skin leg biopsies performed in patients without ulcer and in control patients with HLU. METHODS: We performed a retrospective study between January 2013 and July 2014. Patients were included if they had undergone a deep skin biopsy on the lower limbs, in the absence of any leg ulcer. Controls were patients with typical HLU. RESULTS: Fifty-eight patients and 6 controls were included. Hypertension was present in 25 patients (43%). Arteriolosclerosis, defined as fibrous endarteritis, was present in 35 out of 58 patients (60%) and in all of the controls. No hyalinosis or hyperplastic proliferative arteriolosclerosis was observed in the patients or controls. Only age was an independent factor associated with the presence of cutaneous arteriolosclerosis (p &x#3c; 0.0001). CONCLUSION: Cutaneous arteriolosclerosis is significantly and independently associated with age. Thus, skin biopsy seems not to be necessary for the diagnosis of HLU but only for a differential diagnosis.

Endarteritis de tubo valvulado aórtico por Propionibacterium acnes / Aortic tube infections due to Propionibacterium acnes

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Endarteritis obliterans in the pathogenesis of Buerger's disease from the pathological and immunohistochemical points of view.

Buerger's disease (thromboangiitis obliterans) is considered to be a nonatherosclerotic, inflammatory, and vaso-occlusive disease, although the details of the mechanisms of pathogenesis remain unknown. The occurrence of the disease is strongly related to tobacco abuse and its progression is closely linked to continued smoking. The purpose of this review article is to demonstrate the pathological characteristics of arteries affected with Buerger's disease from a possible immunoreactive point of view. In addition, we present the mechanisms for preserving the architecture of the arterial wall in affected vasculatures. Thereafter, we discuss the possibility that the pathogenesis of Buerger's disease is a type of endarteritis obliterans, deeply connected to the Notch pathway, distinct from arteriosclerosis obliterans and other vasculitides.

Multisite infective endocarditis/endarteritis in a young peripartum patient with patent ductus arteriosus and rheumatic heart valve disease: a case report.

Infective endocarditis (IE) is rarely seen in pregnancy and puerperal period, and generally occurs in patients with preexisting heart disease or intravenous drug abuse. In this report, we describe a case of a 27-year-old patient with missed diagnosis of rheumatic heart disease and a moderate size patent ductus arteriosus, in whom multisite culture-negative IE/pulmonary endarteritis developed after uncomplicated vaginal delivery.

[Chronic angiospastic arterial ischemia of limbs in the patients of elderly and senile age].

The experience of examination and treatment of about 3000 patients having chronic arterial ischemia of extremities allowed to determine that such a clinical presentation appears as a result of functional organic diseases of arteries of extremities: arterial vasoconstriction and obliterating disease of arteries (obliterating atherosclerosis, obliterating endoarteritis, diabetic angiopathy). Chronic ischemia of extremities develops from arterial vasoconstriction of central genesis and then obliterating disease of arteries joins the process. The paper is devoted to the first phase of development of chronic arterial ischemia of extremities: vertebragenous angiospastic disease of arteries of extremities and its treatment for patients of middle and old age.

Neonatal infective endarteritis complicating patent ductus arteriosus.

UNLABELLED: Infective endarteritis complicating patent ductus arteriosus (PDA) is a rare occurrence. Most cases are reported in older children and adults, and there are little published data describing this condition in the preterm neonate. We outline the presentation, clinical course, management and outcome of two affected infants born at less than 27 weeks of gestation. CONCLUSION: This report highlights the importance of a detailed cardiac evaluation in a neonate with persisting bacteraemia. An increasing awareness of neonatal ductal endarteritis combined with the wider availability of more sensitive echocardiography has implications for local neonatal service delivery.

Endarteritis infecciosa en conducto arterioso persistente y embolismo pulmonar séptico / Infective endarteritis in patent ductus arteriosus and septic pulmonary embolism

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Pulmonary endarteritis.

Pulmonary arterial endarteritis is a rare event even in patients with congenital heart disease. In this paper, the authors report two cases of pulmonary endarteritis diagnosed at autopsy. The first was a 3-month-old male infant with absence of congenital heart defect (who had had neonatal sepsis). This patient presented with pneumonia and succumbed within 36 hours of hospital stay despite appropriate antimicrobial therapy and supportive management. The second patient was a 13-month-old male child with previously undiagnosed tetralogy of Fallot who had clinical presentation of acute meningitis with convulsions and succumbed within 12 hours of hospital stay despite adequate treatment. The main autopsy findings were chronic arteritis of the pulmonary trunk and right pulmonary artery in the former and rupture of the pulmonary trunk in the latter.

A patient with insidious onset of exertional dyspnoea.

The case history is presented of a 42 year old woman with pulmonary artery occlusion due to tuberculous vasculitis that masqueraded as chronic pulmonary artery embolism and led to severe life threatening haemoptysis necessitating emergency pneumonectomy. It is concluded that obliterative tuberculous endarteritis of the pulmonary arteries should be considered in the differential diagnosis of any acquired obstruction of pulmonary arteries.