RESUMEN
We report the use of glutaraldehyde (GA) in a case of valve repair for mitral valve prolapse associated with active infective endocarditis. GA scrubbed at the site of infection decontaminates and reinforces infected fragile tissue, avoids excessive debridement, and strengthens the edges of valve leaflets to facilitate suturing.
Asunto(s)
Endocarditis Bacteriana/cirugía , Fijadores , Glutaral/uso terapéutico , Anuloplastia de la Válvula Mitral , Prolapso de la Válvula Mitral/cirugía , Válvula Mitral/cirugía , Infecciones Estreptocócicas/cirugía , Streptococcus/aislamiento & purificación , Técnicas de Sutura , Endocarditis Bacteriana/complicaciones , Endocarditis Bacteriana/microbiología , Humanos , Válvula Mitral/microbiología , Prolapso de la Válvula Mitral/microbiología , Infecciones Estreptocócicas/complicaciones , Infecciones Estreptocócicas/microbiología , Resultado del TratamientoAsunto(s)
Anemia , Ecocardiografía Transesofágica , Endocarditis Bacteriana Subaguda , Prolapso de la Válvula Mitral , Tomografía Computarizada por Rayos X , Estreptococos Viridans , Adulto , Anemia/complicaciones , Anemia/diagnóstico por imagen , Anemia/tratamiento farmacológico , Anemia/microbiología , Endocarditis Bacteriana Subaguda/complicaciones , Endocarditis Bacteriana Subaguda/diagnóstico por imagen , Endocarditis Bacteriana Subaguda/tratamiento farmacológico , Endocarditis Bacteriana Subaguda/microbiología , Femenino , Humanos , Prolapso de la Válvula Mitral/complicaciones , Prolapso de la Válvula Mitral/diagnóstico por imagen , Prolapso de la Válvula Mitral/tratamiento farmacológico , Prolapso de la Válvula Mitral/microbiologíaRESUMEN
OBJECTIVE: To determine the incidence and predictors of infective endocarditis (IE) in a population-based cohort of patients with mitral valve prolapse (MVP). PATIENTS AND METHODS: We identified all adult Olmsted County residents with MVP diagnosed by echocardiography from January 1989 to December 1998 and cross-matched them with the Rochester Epidemiology Project-identified Olmsted County cases of IE from January 1, 1986, through December 31, 2006. We retrospectively analyzed and de novo confirmed each IE case using the modified Duke criteria. RESULTS: There were 896 Olmsted County residents with echocardiographically diagnosed MVP (mean age, 53±21 years; 565 women [63%]). The mean follow-up period was 11±5 years. The 15-year cohort risk of IE after MVP diagnosis was 1.1%±0.4% (incidence, 86.6 cases per 100,000 person-years; 95% CI, 43.3-173.2 cases per 100,000 person-years); thus, the age- and sex-adjusted relative risk of IE in patients with MVP was 8.1 (95% CI, 3.6-18.0) in comparison to the general population of Olmsted County (P<.001). There were no IE cases in patients without previously diagnosed mitral regurgitation (MR). Conversely, IE incidence was higher in patients with MVP with moderate, moderate-severe, or severe MR (289.5 cases per 100,000 person-years; 95% CI, 108.7-771.2 cases per 100,000 person-years; P=.02 compared with trivial, mild, or mild-moderate MR) and in patients with a flail mitral leaflet (715.5 cases per 100,000 person-years; 95% CI, 178.9-2861.0 cases per 100,000 person-years; P=.02 compared with no flail mitral leaflet). CONCLUSION: The population-based incidence of IE in adults with MVP is higher than those previously reported in case-control, tertiary care center studies. Patients with MVP and moderate, moderate-severe, or severe MR or a flail mitral leaflet are at a notable risk of developing IE in comparison with those without MR.
Asunto(s)
Endocarditis/etiología , Endocarditis/microbiología , Prolapso de la Válvula Mitral/complicaciones , Prolapso de la Válvula Mitral/microbiología , Vigilancia de la Población , Adulto , Anciano , Estudios de Cohortes , Ecocardiografía , Endocarditis/epidemiología , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Minnesota/epidemiología , Prolapso de la Válvula Mitral/epidemiología , Estudios Retrospectivos , Factores de RiesgoRESUMEN
A wide and redundant prolapse of the posterior mitral leaflet in active infective endocarditis cannot be easily repaired. A sliding plasty can be attempted, but the range of annular plication is often too large. Chordal replacement is another option, but is prone to long-term degeneration because the redundant leaflet still exists. Here, we describe a simple resection technique that utilizes only two small triangular resections. The resections are sutured with no need to shorten the annulus. The leaflet tissue between the two triangular resections must be preserved to make an appropriately shaped posterior leaflet.
Asunto(s)
Endocarditis Bacteriana/cirugía , Anuloplastia de la Válvula Mitral/métodos , Prolapso de la Válvula Mitral/cirugía , Infecciones Estreptocócicas/cirugía , Antibacterianos/uso terapéutico , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/microbiología , Humanos , Masculino , Persona de Mediana Edad , Prolapso de la Válvula Mitral/diagnóstico , Prolapso de la Válvula Mitral/microbiología , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/microbiología , Streptococcus mitis/aislamiento & purificación , Resultado del TratamientoRESUMEN
We present the case of a 42-year-old man with mitral valve prolapse (MVP) and infective endocarditis. He was referred to our hospital by his family physician for the evaluation of a cardiac murmur. A detailed medical history revealed that he had been feeling fatigue with occasional episodes of slight fever during the last two months. Echocardiography revealed MVP with a sizeable vegetation and severe mitral insufficiency. Serial blood cultures were positive for Streptococcus viridans, highly penicillin susceptible. He was put on appropriate antimicrobial therapy, but both the vegetation and the concomitant mitral insufficiency persisted after otherwise successful medical therapy. Thus, the patient underwent surgical vegetectomy with mitral valve repair. He had an uneventful postoperative course and remains free of disease at the 12-month follow up. Our case report reinforces the value of early diagnosis in the presence of a high clinical suspicion of MVP endocarditis. An extended clinical workup, including serial detailed echocardiography studies, is mandatory in such a patient. Medical treatment of infective endocarditis in the setting of MVP is often successful. However, cardiac surgical intervention plays an important role in the treatment of intracardiac complications. Mitral valve repair in the context of a healed and stable infective endocarditis is the treatment of choice.
Asunto(s)
Endocarditis Bacteriana/cirugía , Prolapso de la Válvula Mitral/cirugía , Infecciones Estreptocócicas/terapia , Estreptococos Viridans , Adulto , Endocarditis Bacteriana/complicaciones , Endocarditis Bacteriana/diagnóstico , Humanos , Masculino , Prolapso de la Válvula Mitral/diagnóstico , Prolapso de la Válvula Mitral/microbiología , Infecciones Estreptocócicas/diagnósticoAsunto(s)
Procedimientos Quirúrgicos Cardíacos , Endocarditis/cirugía , Insuficiencia de la Válvula Mitral/cirugía , Prolapso de la Válvula Mitral/cirugía , Pericardio/trasplante , Infecciones Estreptocócicas/cirugía , Streptococcus mitis/aislamiento & purificación , Adulto , Animales , Bovinos , Ecocardiografía Doppler en Color , Ecocardiografía Tridimensional , Ecocardiografía Transesofágica , Endocarditis/diagnóstico por imagen , Endocarditis/microbiología , Femenino , Humanos , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/microbiología , Prolapso de la Válvula Mitral/diagnóstico por imagen , Prolapso de la Válvula Mitral/microbiología , Infecciones Estreptocócicas/diagnóstico por imagen , Infecciones Estreptocócicas/microbiología , Resultado del TratamientoAsunto(s)
Fístula Arteriovenosa/etiología , Arteria Axilar , Infecciones Estafilocócicas/complicaciones , Fístula Arteriovenosa/microbiología , Fístula Arteriovenosa/patología , Arteria Axilar/patología , Femenino , Humanos , Prolapso de la Válvula Mitral/complicaciones , Prolapso de la Válvula Mitral/microbiología , Infecciones Estafilocócicas/microbiología , Infecciones Estafilocócicas/patología , Adulto JovenRESUMEN
Granulicatella elegans is a fastidious organism that is rarely implicated as a cause of infective endocarditis. Here, we describe a patient with mitral valve prolapse who developed G. elegans endocarditis. The organism was isolated from blood cultures and the patient had mitral valvuloplasty and repair, and completed a course of 6 weeks of intravenous antibiotics with no sequela.
Asunto(s)
Endocarditis Bacteriana , Cocos Grampositivos/aislamiento & purificación , Prolapso de la Válvula Mitral/microbiología , Prolapso de la Válvula Mitral/cirugía , Antibacterianos/uso terapéutico , Sangre/microbiología , Medios de Cultivo , Endocarditis Bacteriana/tratamiento farmacológico , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/cirugía , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/microbiología , Infecciones por Bacterias Grampositivas/cirugía , Cocos Grampositivos/clasificación , Cocos Grampositivos/genética , Humanos , MasculinoAsunto(s)
Endocarditis Bacteriana/microbiología , Infecciones por Bacterias Gramnegativas/microbiología , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/microbiología , Prolapso de la Válvula Mitral/diagnóstico por imagen , Prolapso de la Válvula Mitral/microbiología , Staphylococcus/aislamiento & purificación , Adulto , Coagulasa , Humanos , Masculino , Especificidad de la Especie , UltrasonografíaRESUMEN
We describe 3 cases of endocarditis after acute Q fever in 3 patients with clinically silent, undiagnosed valvulopathies, including mitral valve prolapse, minimal valvular leak, and biscuspid aortic valve. We conclude that, to prevent endocarditis, these minor valvulopathies must be actively searched for with echocardiography after diagnosis of acute Q fever.
Asunto(s)
Endocarditis Bacteriana/etiología , Enfermedades de las Válvulas Cardíacas/diagnóstico por imagen , Fiebre Q/complicaciones , Válvula Aórtica/anomalías , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/microbiología , Ecocardiografía , Endocarditis Bacteriana/diagnóstico por imagen , Endocarditis Bacteriana/patología , Femenino , Enfermedades de las Válvulas Cardíacas/complicaciones , Enfermedades de las Válvulas Cardíacas/microbiología , Humanos , Masculino , Persona de Mediana Edad , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/microbiología , Válvula Mitral/patología , Prolapso de la Válvula Mitral/complicaciones , Prolapso de la Válvula Mitral/diagnóstico por imagen , Prolapso de la Válvula Mitral/microbiologíaRESUMEN
INTRODUCTION: Isolating aetiological agents in patients with infective endocarditis (IE) remains problematical. We postulated that the high local incidence of culture-negative IE resulted from antibiotic exposure prior to blood cultures and that a structured delay in therapy in the subacute presentation would improve the diagnostic yield. AIM: We aimed to prospectively observe the diagnostic approach and give an overview of supplementary laboratory tests. STUDY DESIGN: Patients with suspected IE were enrolled into this analytical observational study and followed up for six months (n = 92). We compared the diagnostic yield and outcome in cases where antibiotics were withheld for 72 hours, with those cases who received early antimicrobials, despite being deemed safe for delayed therapy. RESULTS: Definitive diagnoses (definite or excluded IE) were made in 92.8% of patients where antibiotics were delayed, compared to 60% of patients who received empirical treatment (p = 0.08). The mortality rates were 18.4% and 30.0% (p = 0.18). Twenty-three of 26 patients with definite culture-negative IE received antibiotics during the 48 hours preceding cultures, compared to eight of 21 culture-positive patients (P < 0.001). Screening for atypical bacteria did not improve the yield. C-reactive protein (CRP) had a sensitivity of 97.0% (negative predictive value 87.5%), whereas a positive rheumatoid factor (RF) had a specificity of 93.8% (positive predictive value 91.7%). CONCLUSIONS: We observed tendencies towards a greater diagnostic yield and lower mortality where antibiotics were initially withheld. Antibiotic prior to blood cultures were an important cause of culture-negative IE. A normal CRP proved useful in excluding IE; a positive RF strongly favoured IE.
Asunto(s)
Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/microbiología , Infecciones por Bacterias Gramnegativas/diagnóstico , Infecciones por Bacterias Gramnegativas/microbiología , Infecciones por Bacterias Grampositivas/diagnóstico , Infecciones por Bacterias Grampositivas/microbiología , Antibacterianos/uso terapéutico , Biomarcadores/sangre , Proteína C-Reactiva/metabolismo , Diagnóstico Diferencial , Endocarditis Bacteriana/tratamiento farmacológico , Endocarditis Bacteriana/mortalidad , Estudios de Seguimiento , Bacterias Gramnegativas/aislamiento & purificación , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Gramnegativas/mortalidad , Bacterias Grampositivas/aislamiento & purificación , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/mortalidad , Humanos , Incidencia , Prolapso de la Válvula Mitral/diagnóstico , Prolapso de la Válvula Mitral/tratamiento farmacológico , Prolapso de la Válvula Mitral/microbiología , Valor Predictivo de las Pruebas , Estudios Prospectivos , Cardiopatía Reumática/diagnóstico , Cardiopatía Reumática/tratamiento farmacológico , Cardiopatía Reumática/microbiología , Factor Reumatoide/metabolismo , Sensibilidad y Especificidad , Sudáfrica/epidemiología , Análisis de SupervivenciaAsunto(s)
Dermatitis Atópica/microbiología , Endocarditis Bacteriana/microbiología , Infecciones Estafilocócicas , Adolescente , Ecocardiografía Transesofágica , Endocarditis Bacteriana/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Prolapso de la Válvula Mitral/diagnóstico por imagen , Prolapso de la Válvula Mitral/microbiologíaRESUMEN
A 26-year-old male patient with mitral valve prolapse and HLA-B27 antigen received endodontic treatment for dental caries. Two weeks later fever, dysuria, diarrhea, sterile inflammatory arthritis of lower limbs, enthesitis, dactylitis, conjunctivitis, and uveitis consecutively developed. Blood culture performed at the time of active arthritis yielded Streptococcus viridans. He did not have any history of psoriasis, acute infectious diarrhea, chronic inflammatory bowel diseases, or sexually transmitted diseases. Laboratory studies also excluded the possibility of infections by human immunodeficiency virus, hepatitis B or C virus, chlamydia, and streptococci from the upper airway. This report indicates that Streptococcus viridans can be the triggering microorganisms of Reiter's syndrome in some circumstances.
Asunto(s)
Artritis Reactiva/inmunología , Artritis Reactiva/microbiología , Antígeno HLA-B27/análisis , Infecciones Estreptocócicas/complicaciones , Infecciones Estreptocócicas/inmunología , Adulto , Humanos , Masculino , Prolapso de la Válvula Mitral/inmunología , Prolapso de la Válvula Mitral/microbiologíaRESUMEN
The data from patients with mitral valve prolapse and infective endocarditis were analysed. Twenty-one patients were found, including 13 males and 8 females, with a mean age of 32 years old (range 9 to 61 years). They accounted for 23% of all patients with infective endocarditis, and 48% of those with mitral valve endocarditis diagnosed in our hospital between Jan, 1984 to Dec, 1996. The clinical features were indistinct onset, high incidence of serious complications such as cardiac failure and emboli to large vessels, especially cerebral vessel. Echocardiography played an important role in the diagnosis of the disease.
Asunto(s)
Endocarditis Bacteriana , Prolapso de la Válvula Mitral/microbiología , Infecciones Estreptocócicas , Adolescente , Adulto , Niño , Endocarditis Bacteriana/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prolapso de la Válvula Mitral/diagnóstico por imagen , Infecciones Estreptocócicas/diagnóstico por imagen , UltrasonografíaRESUMEN
Native valve endocarditis normally presents with fever and only later in its course demonstrates dysfunction of the affected valve. We describe a case of endocarditis due to Neisseria subflava, a Gram-negative diplococcal saprophyte of the oral cavity, which was unsuspected clinically and found unexpectedly during a mitral valve operation performed for symptomatic prolapse with regurgitation.
Asunto(s)
Endocarditis Bacteriana/diagnóstico , Válvula Mitral/microbiología , Neisseria , Infecciones por Neisseriaceae/diagnóstico , Estudios de Seguimiento , Enfermedades de las Válvulas Cardíacas/microbiología , Humanos , Masculino , Persona de Mediana Edad , Insuficiencia de la Válvula Mitral/microbiología , Prolapso de la Válvula Mitral/microbiología , Neisseria/clasificaciónRESUMEN
Haemophilus parainfluenzae is a frequent cause of "culture-negative" endocarditis (i.e., endocarditis owing to a fastidious organism which may require longer incubation periods and/or enrichment media for detection compared to traditional pathogens). More cases will probably be identified with improvements in growth and isolation techniques. A case of H. parainfluenzae endocarditis is presented in a patient with mitral valve prolapse, which illustrates the difficulty in diagnosing endocarditis when initial blood cultures are negative. Particularly, it emphasizes the difficulty in selecting appropriate antibiotic therapy since beta-lactamase producing organisms are being isolated with increased frequency. This report is unique in that it documents successful treatment with a cephalosporin and what is, to our knowledge, the third reported case of a beta-lactamase producing H. parainfluenzae causing endocarditis. The authors believe that beta-lactamase stable second or third generation cephalosporins should constitute initial treatment of H. parainfluenzae endocarditis until sensitivity studies become available, since beta-lactamase production by this organism would nullify the effect of the previous agent of choice, ampicillin.
Asunto(s)
Endocarditis Bacteriana/microbiología , Infecciones por Haemophilus/microbiología , Prolapso de la Válvula Mitral/microbiología , Adulto , Cefamandol/uso terapéutico , Endocarditis Bacteriana/tratamiento farmacológico , Femenino , Haemophilus/enzimología , Haemophilus/aislamiento & purificación , Infecciones por Haemophilus/tratamiento farmacológico , Humanos , beta-Lactamasas/biosíntesisRESUMEN
Cases of infective endocarditis superimposed upon prolapsing mitral valves were first described two decades ago. In the intervening years 72 reports in the English-language literature have described 267 such cases. Men predominated numerically in cases occurring after the age of 40 years and in surgical and autopsy series. In cases with auscultatory abnormalities documented before the onset of infective endocarditis, murmurs-and not merely isolated systolic clicks--were usually present. Complications of infective endocarditis were relatively common, and at least 42 patients required valve replacement in the acute phase of illness or during convalescence. Although viridans streptococci were the most frequent etiologic agents (46% of cases), deaths occurred primarily among patients infected with other organisms and among those over 40 years of age. Mitral valve prolapse is increasingly being recognized as a precursor of infective endocarditis because of its high prevalence in the general population and the wider availability of echocardiographic diagnostic techniques. The risk/benefit and cost/benefit ratios for endocarditis prophylaxis in patients with prolapsing mitral valves remain controversial.
Asunto(s)
Endocarditis/complicaciones , Prolapso de la Válvula Mitral/complicaciones , Adolescente , Adulto , Factores de Edad , Anciano , Niño , Endocarditis/microbiología , Femenino , Haemophilus/aislamiento & purificación , Humanos , Masculino , Persona de Mediana Edad , Prolapso de la Válvula Mitral/microbiología , Factores Sexuales , Staphylococcus aureus/aislamiento & purificación , Streptococcus/aislamiento & purificaciónRESUMEN
A case of non-nosocomial, spontaneously occurring endocarditis caused by growth of Stomatococcus mucilaginosus on a prolapsed mitral valve is reported. Despite the organism's high susceptibility in vitro the patient responded slowly to antibiotic treatment. Colony adherence to agar surface and absent or weak catalase reaction differentiated this gram-positive coccus from coagulase-negative staphylococci and micrococci.