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1.
BMC Infect Dis ; 20(1): 907, 2020 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-33256617

RESUMO

BACKGROUND: Corynebacterium diphtheriae (C. diphtheriae) infections, usually related to upper airways involvement, could be highly invasive. Especially in developing countries, non-toxigenic C. diphtheriae strains are now emerging as cause of invasive disease like endocarditis. The present case stands out for reinforcing the high virulence of this pathogen, demonstrated by the multiple systemic embolism and severe valve deterioration. It also emphasizes the importance of a coordinated interdisciplinary work to address all these challenges related to infectious endocarditis. CASE PRESENTATION: A 21-year-old male cocaine drug abuser presented to the emergency department with a 1-week history of fever, asthenia and dyspnea. His physical examination revealed a mitral systolic murmur, signs of acute arterial occlusion of the left lower limb, severe arterial hypotension and acute respiratory failure, with need of vasoactive drugs, orotracheal intubation/mechanical ventilation, empiric antimicrobial therapy and emergent endovascular treatment. The clinical suspicion of acute infective endocarditis was confirmed by transesophageal echocardiography, demonstrating a large vegetation on the mitral valve associated with severe valvular regurgitation. Abdominal ultrasound was normal with no hepatic, renal, or spleen abscess. Serial blood cultures and thrombus culture, obtained in the vascular procedure, identified non-toxigenic C. diphtheriae, with antibiotic therapy adjustment to monotherapy with ampicillin. Since the patient had a severe septic shock with sustained fever, despite antimicrobial therapy, urgent cardiac surgical intervention was planned. Anatomical findings were compatible with an aggressive endocarditis, requiring mitral valve replacement for a biological prosthesis. During the postoperative period, despite an initial clinical recovery and successfully weaning from mechanical ventilation, the patient presented with a recrudescent daily fever. Computed tomography of the abdomen revealed a hypoattenuating and extensive splenic lesion suggestive of abscess. After sonographically guided bridging percutaneous catheter drainage, surgical splenectomy was performed. Despite left limb revascularization, a forefoot amputation was required due to gangrene. The patient had a good clinical recovery, fulfilling 4-weeks of antimicrobial treatment. CONCLUSION: Despite the effectiveness of toxoid-based vaccines, recent global outbreaks of invasive C. diphtheriae infectious related to non-toxigenic strains have been described. These infectious could be highly invasive as demonstrated in this case. Interdisciplinary work with an institutional "endocarditis team" is essential to achieve favorable clinical outcomes in such defiant scenarios.


Assuntos
Abscesso Abdominal/complicações , Infecções por Corynebacterium/complicações , Infecções por Corynebacterium/diagnóstico , Corynebacterium diphtheriae/isolamento & purificação , Embolia/complicações , Endocardite Bacteriana/complicações , Endocardite Bacteriana/diagnóstico por imagem , Abscesso Abdominal/diagnóstico por imagem , Abscesso Abdominal/cirurgia , Ampicilina/uso terapêutico , Amputação , Antibacterianos/uso terapêutico , Infecções por Corynebacterium/microbiologia , Ecocardiografia Transesofagiana , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/cirurgia , Febre , Pé/patologia , Pé/cirurgia , Gangrena , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca , Humanos , Masculino , Valva Mitral/patologia , Valva Mitral/cirurgia , Esplenectomia , Esplenopatias/cirurgia , Resultado do Tratamento , Adulto Jovem
2.
Kyobu Geka ; 73(12): 991-995, 2020 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-33268748

RESUMO

We report a case of successful aortic valve translocation in a 71-year-old man with severe prosthetic valve endocarditis and an aortic annular abscess. Six years earlier, the patient had undergone aortic valve replacement for aortic regurgitation and coronary artery bypass grafting to the left anterior descending artery with a saphenous vein. Moreover, 4 years earlier, he had undergone total arch replacement for chronic aortic dissection. He was admitted to our hospital with suspected urinary tract infection. Despite antibiotic therapy, the patient developed a high fever. Transthoracic echocardiography revealed a rocking motion of the prosthetic aortic valve, and an emergency operation was performed. An annular abscess surrounding the prosthetic aortic valve was observed, and the valve was detached. For destruction of the entire aortic annulus, we performed an aortic valve translocation procedure. Revascularization of the left coronary artery was performed by interposing an 8 mm artificial graft between the proximal anastomosis site of the previous venous graft and the composite tube graft. Revascularization of the right coronary artery was performed using a saphenous vein graft. The patient was discharged uneventfully at postoperative day 29 and doing well 1 year after surgery.


Assuntos
Endocardite Bacteriana , Endocardite , Próteses Valvulares Cardíacas , Abscesso/diagnóstico por imagem , Abscesso/etiologia , Abscesso/cirurgia , Idoso , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/cirurgia , Próteses Valvulares Cardíacas/efeitos adversos , Humanos , Masculino
3.
Kyobu Geka ; 73(12): 1007-1010, 2020 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-33268751

RESUMO

A 70-year-old man, who had undergone aortic valve neocuspidization using his own pericardium 8 months before, complained of back pain, and was diagnosed with pyrogenic spondylitis. As the result of blood culture, Enterococcus faecalis was found to be the causative bacterium, and antibiotic therapy was started. Six days after admission, hemodynamics collapsed suddenly, and percutaneous cardio-pulmonary support was established. Echocardiography showed severe aortic valve regurgitation, and he was diagnosed with active infective endocarditis. We performed re-do aortic valve neocuspidization using bovine pericardium. There was a tear on the non-coronary cusp and the cusps were thickened because of infection. Aortic annular tissue was not destroyed and we could fix the neo-valve directly to the annulus. After these procedures, severe reduction of antero-septal wall motion was noted, which suggested dissection of the main trunk of the left coronary artery. Coronary artery bypass grafting to the left anterior descending and the circumflex branches was added. The patient came off percutaneous cardio-pulmonary support 5 days after surgery. Although trivial aortic regurgitation remained, he was discharged after 2 months of rehabilitation.


Assuntos
Insuficiência da Valva Aórtica , Endocardite Bacteriana , Endocardite , Idoso , Animais , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/cirurgia , Bovinos , Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/cirurgia , Humanos , Masculino , Pericárdio/cirurgia , Pericárdio/transplante
4.
Kyobu Geka ; 73(10): 731-737, 2020 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-33130757

RESUMO

Surgery for active infective endocarditis( IE) carries the greatest risk of any valve surgery, especially when complicated by cerebral infarction or bleeding. Surgical candidates with IE associated with neurologic symptoms should have a neurologic evaluation and brain imaging either by computed tomography (CT) or magnetic resonance imaging (MRI). Even among patients without neurologic symptoms, routine preoperative screening can be justified, especially those with high-risk vegetation. Current recommendations indicate that surgery should be delayed for 1 to 2 weeks in patients with non-hemorrhagic strokes and 3 to 4 weeks in patients with hemorrhagic strokes. If patients have suffered from stroke, any anticoagulation increases the risk of hemorrhagic conversion, and if bleeding has already occurred, this risk further increases. Accordingly, the treatment team has to make a difficult decision whether anticoagulation should be withheld or decreased. Transesophageal echocardiography (TEE) and/or transthoracic echocardiography (TTE) play a major role in determining the size of vegetation, abscess and fistula formation, and severity of regurgitation during the pre- and intra-operative periods. Cerebral MRI/CT are also important to diagnose the severity of cerebral infarction or bleeding before and after surgery. The risk of IE patients with cerebral complication may change by the hour, so a solid heart team approach is mandatory to make a prompt diagnosis and determine the optimal timing for surgery.


Assuntos
Endocardite Bacteriana , Endocardite , Infarto Cerebral , Ecocardiografia , Ecocardiografia Transesofagiana , Endocardite/complicações , Endocardite/cirurgia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/cirurgia , Humanos
5.
Asian Cardiovasc Thorac Ann ; 28(7): 381-383, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33023307
7.
J Cardiovasc Surg (Torino) ; 61(6): 769-775, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32558526

RESUMO

BACKGROUND: Surgical management of aortic valve endocarditis in high risk patients is controversial and the ideal treatment has not been found yet. We describe a selected series of eight patients treated with rapid-deployment aortic valve prosthesis as a therapeutic solution for minimizing the risks associated with annulus manipulation in case of severe aortic infective endocarditis. METHODS: Eight consecutive patients (five men and three women) with a mean age of 74.3±7.2 years, mean logistic EuroSCORE II of 16.0%±0.1%, affected by aortic native (1 patient), or prosthetic valve endocarditis (7 patients), were treated with Edwards Intuity Elite implantation. Hemodynamic performance and infective data were collected pre-, intra-, and postoperatively with a mean follow-up of 2.7±0.7 years. RESULTS: One case of in-hospital mortality was noted. None of the patients had any embolic or infective complication postoperatively. The cardiopulmonary bypass and aortic cross-clamp times were 148.4±41.6 and 90.5±25.3 min, respectively. The postoperative echocardiographic controls indicated a mean transvalvular gradient of 16.7±3.0 mmHg and one case of paravalvular leaks (2 +). Two patients underwent epigastric permanent pacemaker implantation. During the follow-up, seven patients were alive, with no evidence of symptoms or recurrences of endocarditis or embolic episodes. No new paravalvular leaks were noted, and the mean gradient on the valves was 12.4±3.4 mmHg. CONCLUSIONS: Rapid deployment aortic valve replacement in selected very high-risk patients affected by infective endocarditis could be a reasonable choice with acceptable results. However, further studies are needed to confirm these results.


Assuntos
Insuficiência da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Endocardite Bacteriana/cirurgia , Implante de Prótese de Valva Cardíaca , Duração da Cirurgia , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/fisiopatologia , Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/fisiopatologia , Feminino , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Hemodinâmica , Humanos , Masculino , Recuperação de Função Fisiológica , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
8.
J Card Surg ; 35(6): 1351-1353, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32531128

RESUMO

The novel coronavirus, now termed SARS-CoV-2, has caused a significant global impact in the space of 4 months. Almost all elective cardiac surgical operations have been postponed in order to reduce transmission and to allocate resources adequately. Urgent and emergency cardiac surgery is still taking place during the pandemic. The decision to operate in urgent patients with active/recent COVID-19 infection is difficult to make, particularly as it is still an unknown disease entity in the setting of emergent cardiac surgery. We present a case series of three patients who underwent urgent cardiac surgery and who have had recent or active COVID-19 infection.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Infecções por Coronavirus/complicações , Procedimentos Cirúrgicos Eletivos/métodos , Segurança do Paciente , Pneumonia Viral/complicações , Adulto , Idoso , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Serviço Hospitalar de Emergência , Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/cirurgia , Humanos , Masculino , Parada Cardíaca Extra-Hospitalar/diagnóstico por imagem , Parada Cardíaca Extra-Hospitalar/cirurgia , Pandemias/estatística & dados numéricos , Pneumonia Viral/diagnóstico , Prognóstico , Medição de Risco , Gestão da Segurança , Amostragem , Tempo para o Tratamento , Resultado do Tratamento
9.
J Card Surg ; 35(7): 1717-1720, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32598498

RESUMO

We present a 57-year-old man with recent Streptococcus viridans endocarditis on mitral and aortic valves who had a mycotic aneurysm of the left anterior descending (LAD) coronary artery and associated superior mesenteric and cerebral artery aneurysms. The patient had preoperative renal failure and the infection was controlled with ceftriaxone. Mitral and aortic valve replacement were performed using tissue valves and the LAD aortic aneurysm was ligated and the patient had saphenous venous graft to the LAD. The postoperative course was complicated by pleural effusion and the patient had antibiotic therapy for 6 weeks postoperatively.


Assuntos
Antibacterianos/administração & dosagem , Valva Aórtica/cirurgia , Aneurisma Coronário/etiologia , Aneurisma Coronário/cirurgia , Ponte de Artéria Coronária/métodos , Vasos Coronários/cirurgia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/cirurgia , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/cirurgia , Valva Mitral/cirurgia , Endocardite Bacteriana/microbiologia , Doenças das Valvas Cardíacas/microbiologia , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Ligadura/métodos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Veia Safena/transplante , Infecções Estreptocócicas , Resultado do Tratamento , Estreptococos Viridans
10.
Ann Thorac Surg ; 110(6): e509-e511, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32445631

RESUMO

Surgery for infective endocarditis in the pulmonary position is an effective method of treatment despite a very uncommon pathology and few operations being performed. We present an adult male patient with right-sided infective endocarditis where the pulmonary valve cusps were almost completely damaged. The pulmonary valve was successfully reconstructed using glutaraldehyde-treated autologous pericardium by the Ozaki technique. The Ozaki repair was originally described for aortic valve repair in various aortic valve diseases.


Assuntos
Endocardite Bacteriana/cirurgia , Valva Pulmonar/cirurgia , Adulto , Glutaral , Humanos , Masculino , Pericárdio/transplante , Procedimentos Cirúrgicos Vasculares/métodos
11.
BMC Cardiovasc Disord ; 20(1): 246, 2020 05 25.
Artigo em Inglês | MEDLINE | ID: mdl-32450792

RESUMO

BACKGROUND: Prosthetic valve endocarditis (PVE) is a serious complication, and it is difficult to treat marked adhesion and infectious tissue. CASE PRESENTATION: There were four patients with aortic PVE, whose ages ranged from 59 to 80 years. In all patients, transoesophageal echocardiography revealed periannular abscess formation. We applied aortic annular enlargement techniques using a composite three-layer patch to repair the defects after radical debridement of the abscesses, and then replaced the prosthetic valves on the reconstructed annuli. All patients received antibiotics after surgery and recovered well without recurrence. CONCLUSIONS: The aortic annular enlargement techniques provided a good field of vision at the complicated annulus, and our original patch was useful for repairing the aortic annulus and its surrounding apparatus.


Assuntos
Abscesso/cirurgia , Valva Aórtica/cirurgia , Procedimentos Cirúrgicos Cardíacos , Endocardite Bacteriana/cirurgia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Pericárdio/transplante , Infecções Relacionadas à Prótese/cirurgia , Abscesso/diagnóstico por imagem , Abscesso/microbiologia , Idoso , Idoso de 80 Anos ou mais , Animais , Valva Aórtica/diagnóstico por imagem , Bovinos , Remoção de Dispositivo , Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/microbiologia , Feminino , Xenoenxertos , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/microbiologia , Resultado do Tratamento
12.
Circ J ; 84(6): 926-934, 2020 05 25.
Artigo em Inglês | MEDLINE | ID: mdl-32295976

RESUMO

BACKGROUND: Infective endocarditis remains associated with substantial mortality and morbidity rates, and the presence of acute heart failure (AHF) compromises clinical results after valve surgery; however, little is known in cardiogenic shock (CGS) patients. This study evaluated the clinical results and risk of mortality in CGS patients after valve surgery.Methods and Results:This study enrolled 585 patients who underwent valve surgery for active endocarditis at 14 institutions between 2009 and 2017. Of these patients, 69 (12%) were in CGS, which was defined as systolic blood pressure <80 mmHg and severe pulmonary congestion, requiring mechanical ventilation and/or mechanical circulatory support, preoperatively. The predictors of CGS were analyzed, and clinical results of patients with non-CGS AHF (n=215) were evaluated and compared.Staphylococcus aureusinfection (odds ratio [OR] 2.19; P=0.044), double valve involvement (OR 3.37; P=0.003), and larger vegetation (OR 1.05; P=0.036) were risk factors for CGS. Hospital mortality occurred in 27 (13%) non-CGS AHF patients and in 15 (22%) CGS patients (P=0.079). Overall survival at 1 and 5 years in CGS patients was 76% and 69%, respectively, and there were no significant differences in overall survival compared with non-CGS AHF patients (P=1.000). CONCLUSIONS: Clinical results after valve surgery in CGS patients remain challenging; however, mid-term results were equivalent to those of non-CGS AHF patients.


Assuntos
Circulação Assistida , Endocardite Bacteriana/cirurgia , Oxigenação por Membrana Extracorpórea , Implante de Prótese de Valva Cardíaca , Choque Cardiogênico/terapia , Idoso , Circulação Assistida/efeitos adversos , Circulação Assistida/mortalidade , Bases de Dados Factuais , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/mortalidade , Endocardite Bacteriana/fisiopatologia , Oxigenação por Membrana Extracorpórea/efeitos adversos , Oxigenação por Membrana Extracorpórea/mortalidade , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/mortalidade , Mortalidade Hospitalar , Humanos , Balão Intra-Aórtico , Japão , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/mortalidade , Choque Cardiogênico/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
13.
Ann Thorac Surg ; 110(5): 1615-1621, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32315643

RESUMO

BACKGROUND: Left-sided staphylococcal, streptococcal, and enterococcal infective endocarditis (IE) is associated with poor clinical outcomes. Our primary aim is to compare clinical outcomes of staphylococcal, streptococcal, and enterococcal IE patients who undergo valve replacement surgery and outcomes of patients who are treated solely with antibiotics. METHODS: All patients were treated medically or surgically for left-sided staphylococcal, streptococcal, or enterococcal IE at our institution from 1998 to 2014 and were retrospectively studied. The primary outcome of interest was 30-day and 1-year mortality, and secondary outcomes included posttreatment septic shock, embolic events, stroke, and end-stage renal disease at 30 days. Inverse probability treatment weights, derived from propensity scores, were used to balance the medical and surgical cohorts across clinical risk factors, The Society of Thoracic Surgeon scores, and pathogens. Outcomes were compared comprehensively and in a staphylococcal-only subanalysis. RESULTS: Study population consisted of 245 surgical patients and 164 medical patients. Mortality at 30 days was higher in the medical cohort, both in aggregate and for staphylococcal only (all, 7% vs 16%, P < .001; staphylococcal only, 7% vs 22%, P < .001). Surgical patients had a higher incidence of septic shock and renal dysfunction; however, stroke and embolic events at 30 days were not different between cohorts. Cox survival analysis demonstrated that surgical treatment provided a 1-year survival benefit, with a hazard ratio of 0.48 (95% confidence interval, 0.36 to 0.64) that was robust regardless of pathogen. CONCLUSIONS: Compared with medical management, valve replacement surgery in patients with left-sided staphylococcal, streptococcal, or enterococcal IE appears to confer a survival advantage at 30 days and 1 year.


Assuntos
Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Idoso , Endocardite Bacteriana/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Retrospectivos
15.
Sci Rep ; 10(1): 7179, 2020 04 28.
Artigo em Inglês | MEDLINE | ID: mdl-32346051

RESUMO

Right-sided infective endocarditis (RSIE), classically associated with intravenous drug use or intracardiac devices, is considered a good-prognosis infective endocarditis (IE) form. However, predisposing factors and prognosis for "NODID" RSIE (NOt associated with cardiac Devices or Intravenous Drug use) remain unclear. The aim of this study was to evaluate predisposing factors and prognosis of NODID RSIE compared to other RSIE forms. A retrospective cohort study (January 2008-January 2019) was conducted in a reference center on 300 patients diagnosed with IE. Endocarditis-related events were defined as related to IE in mortality or open-heart surgery during follow-up. A review and meta-analysis of associated literature (January 2008-January 2019) were also performed. Fifty-seven patients presented RSIE (19%), 22 of which were NODID RSIE (39%). Use of intravascular catheters (23% vs 3%; p = 0.027) and congenital heart diseases (18% vs 0%; p = 0.019) were associated with NODID RSIE. This group had a higher in-hospital mortality (23% vs 3%; p = 0.027) and endocarditis-related event rates (41% vs 6%; p = 0.001) than non-NODID RSIE. Furthermore, NODID RSIE was independently associated with in-hospital endocarditis-related events (OR = 19.29; 95%CI:2.23-167.16; p = 0.007). Our meta-analysis evaluated four studies and identified 96 cases (30%) of NODID RSIE from 320 total RSIE cases. NODID RSIE patients demonstrated higher in-hospital mortality (RR = 2.81; 95%CI:1.61-4.90; p < 0.001; I2 = 0.0%) and necessity of open-heart surgery (RR = 13.89; 95%CI:4.14-46.60; p < 0.001; I2 = 0.0%) than non-NODID RSIE cases. Our study suggests that NODID RSIE has the highest endocarditis-related event rate and in-hospital mortality among RSIE cases and therefore should not be considered a good-prognosis IE.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Endocardite Bacteriana/mortalidade , Endocardite Bacteriana/cirurgia , Mortalidade Hospitalar , Adulto , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Abuso de Substâncias por Via Intravenosa/mortalidade , Abuso de Substâncias por Via Intravenosa/cirurgia , Taxa de Sobrevida
16.
J Infect Public Health ; 13(5): 821-823, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32241725

RESUMO

Q fever prosthetic valve endocarditis in association with antiphospholipid antibody syndrome (APS) in systemic lupus erythematosus (SLE) has not been previously reported. Here, we report a 22-year-old Saudi female diagnosed with SLE and APS. She had mitral valve replacement with bio-prosthesis five years earlier for Libman-Sack endocarditis. She presented with two months' history of fever, cough, palpitations, and progressive shortness of breath. A transthoracic echocardiogram showed a degenerative mitral valve prosthesis with a large mass causing severe obstruction. Open heart surgery revealed multiple masses on the mitral valve. PCR from the resected tissues was positive for Coxiella burnetii DNA. Q fever serology showed phase two IgG 1:2048, phase one IgG 1:512, and IgM 1:1024. The valve was replaced with a bio-prosthesis. She was well at 12 months of follow-up.


Assuntos
Síndrome Antifosfolipídica/complicações , Bioprótese/efeitos adversos , Endocardite Bacteriana/diagnóstico , Próteses Valvulares Cardíacas/efeitos adversos , Lúpus Eritematoso Sistêmico/complicações , Febre Q/diagnóstico , Procedimentos Cirúrgicos Cardíacos , Coxiella burnetii/isolamento & purificação , DNA Bacteriano/isolamento & purificação , Ecocardiografia , Endocardite Bacteriana/cirurgia , Feminino , Implante de Prótese de Valva Cardíaca , Humanos , Valva Mitral/diagnóstico por imagem , Valva Mitral/patologia , Estenose da Valva Mitral/complicações , Estenose da Valva Mitral/cirurgia , Reação em Cadeia da Polimerase , Febre Q/cirurgia , Resultado do Tratamento , Adulto Jovem
17.
World J Pediatr Congenit Heart Surg ; 11(3): 374-376, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32294009

RESUMO

Scorpion sting envenoming is a common pediatric emergency in the Moroccan southern areas. Cardiomyopathy is the most common cardiovascular manifestation of envenoming, resulting from the stimulation of the sympathetic nervous system by the venom or from the direct effect of the venom toxins on the myocardium. Rare cases of infective endocarditis following a scorpion sting have been reported in the literature. We report a case of tricuspid valve infective endocarditis following a scorpion sting in a previously healthy eight-year-old child. The patient initially was managed medically before undergoing tricuspid valve replacement with a bioprosthesis. The postoperative course was uneventful with a full recovery.


Assuntos
Endocardite Bacteriana/etiologia , Endocardite Bacteriana/cirurgia , Picadas de Escorpião/complicações , Insuficiência da Valva Tricúspide/cirurgia , Valva Tricúspide/microbiologia , Valva Tricúspide/cirurgia , Bioprótese , Cardiomiopatias/etiologia , Criança , Feminino , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca , Humanos , Marrocos , Miocárdio
18.
J Card Surg ; 35(5): 988-995, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32176376

RESUMO

BACKGROUND: To analyze the long-term results after Bentall operation using the stentless Shelhigh No-React (NR)-2000 bio-root prosthesis. MATERIAL: From 2004 to 2008, 26 consecutive, nonselected patients (mean age at surgery: 67 ± 9 years) underwent a Bentall operation using a stentless Shelhigh valved conduit at our institution. Mean preoperative Logistic-EuroSCORE was 17.1 ± 12.9. The mean size of the aortic root was 53.2 ± 5 mm. The mean preoperative ejection fraction was 55 ± 7.4%. Three patients had a bicuspid valve. One patient with acute endocarditis and one patient with type A aortic dissection were operated on an emergency. Three patients (11.54%) had a previous cardiac operation. The Button-Bentall technique was used in all cases. Seven patients (26.92%) received an associated procedure. The mean size of the implanted prosthesis was 26.1 ± 2.2. Follow-up ranged between 6 and 174 months (mean 93.4 ± 59.1 months). Primary endpoints consisted of early and late mortality, freedom from acute endocarditis, freedom from structural valve deterioration, and freedom from valve-related-reoperation. RESULTS: Two patients died in hospital, while 10 patients died during follow-up time, of which three for cardiac causes (12.5%). Overall survival probability was 52.9% at 15 years. Freedom from acute endocarditis was 95.7% at 5 and 15 years. Freedom from severe aortic incompetence due to structural deterioration was 100% at 5 and 10 years, 90.9% at 15 years. The mean aortic gradient at follow-up was 11.4 ± 5 mm Hg. Freedom from valve-related reoperation was 100% at 5 and 10 years, 90.9% at 15 years. CONCLUSIONS: In our experience, Bentall's operation using the Shelhigh NR-2000 stentless bio-conduit provided satisfactory early and long-term results. However, our findings are not consistent with unfavorable long-term outcomes following the implantation of this device reported by other authors.


Assuntos
Aneurisma Dissecante/cirurgia , Valva Aórtica/anormalidades , Valva Aórtica/cirurgia , Endocardite Bacteriana/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Idoso , Idoso de 80 Anos ou mais , Bioprótese , Feminino , Seguimentos , Implante de Prótese de Valva Cardíaca/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Taxa de Sobrevida , Fatores de Tempo , Resultado do Tratamento
19.
J Cardiovasc Electrophysiol ; 31(3): 718-722, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32003095

RESUMO

INTRODUCTION: The optimal approach to the extraction of leads with large vegetations remains uncertain. METHODS: High-risk patients with lead associated vegetations undergoing device extraction at Vanderbilt Hospital with concomitant use of the Penumbra Aspiration System (Penumbra Inc, Alameda, CA) are described. An 8.5 Fr Agilis NXT (Abbott Inc, St. Paul, MN) was advanced to the right atrium, through which a Penumbra Indigo Cat-8 catheter was advanced. Using intracardiac echocardiography, the Penumbra was positioned directly on the vegetation, suction was applied until adherent, and the Indigo catheter and Agilis sheath were then removed en-bloc and aspirated debris flushed out. This was repeated until debulking was considered successful. RESULTS: Eight cases were performed. The median vegetation size was 2 cm. Pathogens were Enterococcus, Staphylococcus, Candida, Cutibacterium, and Enterobacter. In seven of eight cases, aspiration successfully reduced vegetations to less than 1 cm before successful percutaneous cardiac implantable electronic device removal. One patient underwent surgical removal via thoracotomy. There were no acute complications related to the Penumbra catheter. Three patients had CT evidence of small pulmonary emboli postprocedure. The length of stay was 3 to 27 days. One patient died on POD 1 of refractory ventricular tachycardia unrelated to the procedure. One patient died of ongoing sepsis 2 weeks postextraction. CONCLUSIONS: The Penumbra Indigo Aspiration system can be useful for vegetation debulking before transvenous lead extraction.


Assuntos
Desfibriladores Implantáveis/efeitos adversos , Remoção de Dispositivo/instrumentação , Endocardite Bacteriana/cirurgia , Marca-Passo Artificial/efeitos adversos , Infecções Relacionadas à Prótese/cirurgia , Trombectomia/instrumentação , Adulto , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Remoção de Dispositivo/efeitos adversos , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/microbiologia , Fatores de Risco , Sucção/instrumentação , Trombectomia/efeitos adversos , Resultado do Tratamento
20.
Sci Rep ; 10(1): 2690, 2020 02 14.
Artigo em Inglês | MEDLINE | ID: mdl-32060394

RESUMO

This retrospective study aimed to clarify the short- and mid-term outcomes of elderly patients who underwent surgery to treat left-sided native valve infective endocarditis (LSNIE). Between July 2005 and September 2015, 179 patients underwent surgical treatment for active LSNIE at a single institution. Patients were classified into two groups: ≥65 years (elderly group) and <65 years (non-elderly group). Clinical features, surgical information, postoperative complications, and three-year survival rates were compared. The average ages were 74.2 ± 6.4 and 45.2 ± 12.6 years in the elderly and non-elderly groups, respectively. The elderly group had a higher predicted mortality rate and a lower incidence of preoperative septic emboli-related complications. Echocardiographic assessments of infected valves were generally homogenous between the groups. The elderly patients had a higher in-hospital mortality rate than the non-elderly patients (26.3% vs. 5.7%, P = 0.001). For patients who survived to discharge, the three-year cumulative survival rates were 75.0% ± 8.2% and 81.2% ± 3.4% in the elderly and non-elderly groups, respectively (P = 0.484). In conclusion, elderly patients are at a higher risk of in-hospital mortality after surgery for LSNIE. However, once elderly patients are stabilized by surgical treatment and survive to discharge, the mid-term outcomes are promising.


Assuntos
Endocardite Bacteriana/cirurgia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Infecções Relacionadas à Prótese/cirurgia , Infecções Estafilocócicas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Ecocardiografia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/microbiologia , Endocardite Bacteriana/patologia , Feminino , Próteses Valvulares Cardíacas/microbiologia , Implante de Prótese de Valva Cardíaca/métodos , Mortalidade Hospitalar , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/complicações , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/patologia , Estudos Retrospectivos , Fatores de Risco , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/patologia , Resultado do Tratamento
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