RESUMO
Endocarditis is a rare presentation for cytomegalovirus (CMV) infection. We present the case of a 49-year-old man who underwent mitral and tricuspid valve replacement for valvular CMV endocarditis. The patient's past medical history was significant for human immunodeficiency virus, intravenous drug abuse, and chronic hepatitis B. During his clinical course, he was found to have tricuspid and mitral valve vegetations. After progressive valvular destruction despite antibiotic therapy, he underwent successful mitral and tricuspid valve replacement. Pathologic analysis of the culture-negative valve specimens were found to contain inclusion bodies consistent with CMV, and quantitative serum polymerase chain reaction returned a highly elevated CMV DNA count.
Assuntos
Infecções por Citomegalovirus/diagnóstico , Endocardite/cirurgia , Endocardite/virologia , Implante de Prótese de Valva Cardíaca/métodos , Valva Mitral/cirurgia , Valva Tricúspide/cirurgia , Biópsia por Agulha , Infecções por Citomegalovirus/complicações , Ecocardiografia Transesofagiana/métodos , Endocardite/diagnóstico por imagem , Seguimentos , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/cirurgia , Doenças das Valvas Cardíacas/virologia , Próteses Valvulares Cardíacas , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Valva Mitral/patologia , Valva Mitral/virologia , Medição de Risco , Resultado do Tratamento , Valva Tricúspide/patologia , Valva Tricúspide/virologiaRESUMO
OBJECTIVES: To evaluate current strategies to decrease spinal cord and organ dysfunction in patients undergoing repair of descending and thoracoabdominal aneurysms. METHODS: We reviewed 94 consecutive cases of descending and thoracoabdominal aortic aneurysm repairs to determine the impact of modern adjuncts on postoperative neurologic deficit and mortality. The adjuncts used in these patients included perioperative cerebrospinal fluid drainage, distal aortic perfusion, reattachment of critical intercostal vessels, permissive hypothermia and hypothermic circulatory arrest with antegrade cerebral perfusion. Between December 1999 and March 2005, 24/94 (26%) patients were operated on for thoracoabdominal aortic aneurysm type I, seven (7%) for type II, 25/94 (27%) for type III or type IV, and 38/94 (40%) for descending thoracic aneurysms. Perioperative parameters were collected for all patients, and analyzed retrospectively. RESULTS: Twenty (21%) of the patients required hypothermic circulatory arrest for conduction of the operation. The postoperative rate of paraplegia was 3% (3/94). One patient developed temporary paraparesis. Overall operative mortality was 10% (9/94). This included 12/94 (13%) patients who underwent surgery emergently for ruptured or contained rupture of aortic aneurysm. CONCLUSION: Use of perioperative cerebrospinal fluid drainage, distal aortic perfusion and permissive hypothermia result in a low incidence of spinal cord injury and a low operative mortality.
