A rare presentation of mycotic cerebral aneurysm, subarachnoid haemorrhage, and mitral valve aneurysm in left-sided lnfective endocarditis: a case report and literature review.

Background: Infective endocarditis (IE) can present as a syndromic-like condition with multisystem involvement; this can make early diagnosis particularly challenging. Rarely, left-sided IE can lead to mitral valve aneurysm formation. Showering of septic emboli to the cerebral circulation may result in a mycotic aneurysm that can rupture, leading to haemorrhagic stroke, as in this case. Case summary: A 28-year-old male presented with a triad of subarachnoid haemorrhage (SAH) from mycotic cerebral aneurysm rupture, left-sided aortic and mitral valve IE causing severe regurgitation and aorto-mitral curtain fistula and mitral valve aneurysm formation. The SAH was the main initial presentation and was immediately treated with coiling by an interventional radiologist. However, the patient later developed heart failure due to severe aortic and mitral valve regurgitation that led to the diagnosis of IE. The patient underwent aortic and mitral valve replacements procedure10 days after SAH presentation. He then recovered satisfactorily from the operationa and successfully discharged home after completeing his course of intravenous antibiotics. Discussion: In this article, we shed some light on this unusual syndromic presentation, elaborate on the underlying mechanism, the ultimate importance of clinical examination, pitfalls in diagnosis, the important role of the heart team in IE, and finally the timing of surgery after SAH.

Is vacuum-assisted closure therapy the main culprit in right ventricular rupture after deep sternal wound infection?

Right ventricular rupture after deep sternal wound infection (DSWI) is a rare but fatal complication, and can occur with or without vacuum assisted closure (VAC) therapy. There is currently no strong evidence to suggest whether or not VAC therapy is a contributing factor to this complication. In total, 30 articles were retrieved and assessed through a systematic review strategy from 1953 to 2022. The keywords: 'vacuum assisted closure'; 'VAC'; 'negative pressure wound therapy'; 'deep sternal wound infection'; 'DSWI'; 'right ventricular rupture'; and 'cardiac rupture' were used in the search. Overall, 15 of the included articles satisfied the predefined eligibility criteria. Fatal right ventricular ruptures were reported in 18 (36%) out of 50 cases. In this article, the risk factors, mechanisms and management of right ventricular rupture are discussed. A novel view of the mechanism of VAC-associated right ventricular rupture is highlighted, with a focus on both pre- and intraoperative management.