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2.
Ann Card Anaesth ; 26(1): 105-108, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36722599

RESUMO

Three different patients presented to our institution with right-sided infective endocarditis (IE). All three were found to have vegetation on the tricuspid valve. These patients were started on appropriate antimicrobial therapy according to their blood cultures sensitivities. Despite this management, the patients' clinical status did not improve solely on antimicrobials. Surgery was, therefore, indicated to remove the vegetations. Traditionally, the appropriate management would have been invasive surgery. However, these patients were subjected to a novel treatment in our institution for right-sided IE: percutaneous mechanical vegetation debulking with an AngioVac system. After this procedure, all three patients' clinical status improved drastically. This new less invasive approach seems to offer the same results as the traditional invasive surgery, with faster recovery time. More comparative studies are needed to confirm this idea.


Assuntos
Endocardite Bacteriana , Endocardite , Humanos , Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/cirurgia , Endocardite/tratamento farmacológico , Endocardite/cirurgia , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/cirurgia
3.
BMC Neurol ; 23(1): 18, 2023 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-36647036

RESUMO

BACKGROUND: Intramedullary spinal cord abscesses (ISCA) are rare, even more so in association with brain abscesses. Infective endocarditis is an uncommon cause of ISCA. In this case study, we report a patient with intramedullary abscesses and multiple brain abscesses due to subacute infective endocarditis. CASE PRESENTATION: A 54-year-old man presented with a 7-day history of head and neck pain and numbness in both lower limbs. Intramedullary abscess combined with multiple brain abscesses was diagnosed based on blood culture, head and spinal magnetic resonance imaging (MRI), contrast-enhanced MRI, and magnetic resonance spectroscopy. Echocardiography revealed vegetations on the mitral valve and severe mitral regurgitation, which the authors believe was caused by subacute infective endocarditis. With ceftriaxone combined with linezolid anti-infective therapy, the patient's symptoms and imaging was improved during follow-up. CONCLUSIONS: This case hopes to raise the vigilance of clinicians for ISCA. When considering a patient with an ISCA, it is necessary to complete blood culture, MRI of the brain and spinal cord, and echocardiography to further identify whether the patient also has a brain abscess and whether the cause is infective endocarditis.


Assuntos
Abscesso Encefálico , Endocardite Bacteriana , Endocardite , Doenças da Medula Espinal , Masculino , Humanos , Pessoa de Meia-Idade , Abscesso Encefálico/complicações , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/tratamento farmacológico , Endocardite Bacteriana/complicações , Endocardite Bacteriana/diagnóstico por imagem , Doenças da Medula Espinal/complicações , Doenças da Medula Espinal/diagnóstico por imagem , Endocardite/complicações
5.
BMJ Case Rep ; 16(1)2023 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-36669789

RESUMO

The AngioVac aspiration system is a catheter-based technique that has been used for removal of unwanted intravascular material in growing numbers of institutions around the world since 2013. It provides an alternative and a less invasive approach for the treatment of venous thromboembolism and intrinsic or cardiac implantable electronic devices (CIED)-related infective endocarditis. This system uses venous cannulas and extracorporeal filtering mechanisms to effectively remove thrombi or vegetations resulting in less invasion and minimal blood loss. We present a case of a woman in her mid-50s who underwent successful AngioVac-guided removal of lead vegetations followed by percutaneous CIED removal.


Assuntos
Desfibriladores Implantáveis , Endocardite Bacteriana , Endocardite , Marca-Passo Artificial , Infecções Relacionadas à Prótese , Trombose , Feminino , Humanos , Endocardite/etiologia , Endocardite/cirurgia , Endocardite Bacteriana/etiologia , Endocardite Bacteriana/cirurgia , Marca-Passo Artificial/efeitos adversos , Trombose/terapia , Remoção de Dispositivo/métodos , Desfibriladores Implantáveis/efeitos adversos , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/cirurgia
6.
Cardiovasc Ultrasound ; 21(1): 3, 2023 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-36717895

RESUMO

BACKGROUND: Infective endocarditis (IE) is a serious condition that requires prompt diagnosis and treatment. Transthoracic echocardiography (TTE) is usually the initial imaging modality, however transoesophageal echocardiography (TOE) is sometimes necessary because of its higher sensitivity for IE. Yet, TOE may imply an increased risk of complications. This project aims to evaluate whether TTE can be used to a greater extent in the diagnostics of IE to avoid unnecessary TOE examinations without jeopardizing diagnostic accuracy. METHODS: Data from all TOE examinations performed on patients hospitalized with clinical suspicion of IE between 2019-05-01 and 2020-04-30 at a university hospital in Stockholm, Sweden, were obtained and analysed. Variables included for analysis were age, sex, blood culture results, aetiology, results from TOE, number of TOEs during the inclusion period, results from positron emission tomography/computed tomography (PET/CT), new regurgitation, cardiac murmur, previous IE, prosthetic valve, predisposing factors, i.e. cardiac comorbidities, injection drug use, fever, vascular phenomena, and immunological phenomena. To assess associations between predisposing factors or aetiology of IE and TOE findings, chi square tests and logistic regression models were used. For continuous variables, linear regression was used for comparisons of means and quantile regression was used for comparisons of medians. P < 0.05 was considered significant. RESULTS: In total 195 TOE examinations (Table 1) from 160 patients were included, of which 61 (31%) were positive for IE. In total, 36 examinations had negative TTE prior to TOE of which 32 (86%) also had negative TOE. Of the 5 (14%) negative TTE prior to TOE that had positive TOE, all had cardiovascular implantable electronic device (CIED) and/or prosthetic valves. CONCLUSIONS: The existing recommendations for TOE in patients with clinical suspicion of IE are probably broad enough not to miss patients with IE, but there might be an unnecessarily large number of patients being referred for TOE with negative results. Negative TTE examination with good image quality and no CIED or prosthetic valves, may be sufficient without jeopardizing the IE diagnosis.


Assuntos
Endocardite Bacteriana , Endocardite , Humanos , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/efeitos adversos , Ecocardiografia/métodos , Endocardite/diagnóstico por imagem , Endocardite/etiologia , Ecocardiografia Transesofagiana/métodos
9.
Tex Heart Inst J ; 50(1)2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36715976

RESUMO

Left main coronary artery aneurysm is an unusual complication of infective endocarditis. Although this type of aneurysm is often asymptomatic, rupture and thrombus formation that result in myocardial infarction are known complications; therefore, prompt recognition and surgical intervention are warranted. This report describes a patient who presented with a giant left main coronary artery aneurysm 3.5 years after being treated for 4-valve endocarditis. The management and technical aspects of this challenging case are discussed here.


Assuntos
Aneurisma Infectado , Aneurisma Coronário , Endocardite Bacteriana , Endocardite , Humanos , Vasos Coronários , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/cirurgia , Endocardite/cirurgia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/cirurgia , Aneurisma Coronário/diagnóstico , Aneurisma Coronário/diagnóstico por imagem
10.
J Am Coll Cardiol ; 81(4): 394-412, 2023 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-36697140

RESUMO

Infective endocarditis (IE) is a rare but serious complication following transcatheter aortic valve replacement (TAVR). Despite substantial improvements in the TAVR procedure (less invasive) and its expansion to younger and healthier patients, the incidence of IE after TAVR remains stable, with incidence rates similar to those reported after surgical aortic valve replacement. Although IE after TAVR is recognized as a subtype of prosthetic valve endocarditis, this condition represents a particularly challenging scenario given its unique clinical and microbiological profile, the high incidence of IE-related complications, the uncertain role of cardiac surgery, and the dismal prognosis in most patients with TAVR-IE. The number of TAVR procedures is expected to grow exponentially in the coming years, increasing the number of patients at risk of developing this life-threatening complication. Therefore, a detailed understanding of this disease and its complications will be essential to improve clinical outcomes.


Assuntos
Estenose da Valva Aórtica , Endocardite Bacteriana , Endocardite , Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter , Humanos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Endocardite Bacteriana/complicações , Próteses Valvulares Cardíacas/efeitos adversos , Endocardite/diagnóstico , Endocardite/epidemiologia , Endocardite/etiologia , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/complicações , Fatores de Risco , Resultado do Tratamento
11.
J Infect ; 86(2): 123-133, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36603774

RESUMO

OBJECTIVES: We aimed at determining whether specific S. aureus strains cause infective endocarditis (IE) in the course of Staphylococcus aureus bacteraemia (SAB). METHODS: A genome-wide association study (GWAS) including 924 S. aureus genomes from IE (274) and non-IE (650) SAB patients from international cohorts was conducted, and a subset of strains was tested with two experimental animal models of IE, one investigating the early step of bacterial adhesion to inflamed mice valves, the second evaluating the local and systemic developmental process of IE on mechanically-damaged rabbit valves. RESULTS: The genetic profile of S. aureus IE and non-IE SAB strains did not differ when considering single nucleotide polymorphisms, coding sequences, and k-mers analysed in GWAS. In the murine inflammation-induced IE model, no difference was observed between IE and non-IE SAB strains both in terms of adhesion to the cardiac valves and in the propensity to cause IE; in the mechanical IE-induced rabbit model, there was no difference between IE and non-IE SAB strains regarding the vegetation size and CFU. CONCLUSION: All strains of S. aureus isolated from SAB patients must be considered as capable of causing this common and lethal infection once they have accessed the bloodstream.


Assuntos
Bacteriemia , Endocardite Bacteriana , Endocardite , Infecções Estafilocócicas , Animais , Coelhos , Camundongos , Estudo de Associação Genômica Ampla , Bacteriemia/microbiologia , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/genética , Endocardite Bacteriana/microbiologia , Endocardite/microbiologia
12.
J Cardiothorac Surg ; 18(1): 27, 2023 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-36647129

RESUMO

BACKGROUND: Mitral valve repair (MVRe) is considered to have a superior outcome compared to replacement (MVRp) in patients with mitral valve regurgitation (MVR). It was the aim of the study to analyse the clinical results and identify risk factors for short and long-term mortality. METHODS: In a retrospective single-center analysis, patients undergoing an isolated mitral valve procedure from June 2010 to December 2016 were identified. These were subsequently homogenized using 10 baseline characteristics for propensity-score matching. Comparative analyses were performed for early and long-term results, using adequate statistical tools, and identifying risk factors for the investigated endpoints, primary end-point: all-cause mortality within 5 years and secondary end-points: recurrent MVR, reoperation, endocarditis and/or mortality with 30 days, 1, 3 and 5 years. RESULTS: 241 patients were identified in the entire patient cohort. After matching, patients were divided into 2 groups of 64 each respectively. The median age was similar in the two groups. There was a significant interaction between early mortality risk of MV in patients with coronary artery disease (CAD) (OR 11.94, 95% CI 1.49-285.92, p = 0.04) and late mortality in patients with higher EuroSCORE II (HR 1.14, 95% CI 1.06-1.23, p < 0.001). The primary end-point showed 5-year survival rate was significantly higher in MVRe versus MVRp (90.06% vs. 79.54% respectively, p = 0.04). The secondary end-point demonstrated recurrent MVR not to be statistically significant between the 2 groups (p = 0.09) as well as reoperation (p = 0.28). Endocarditis was observed in one patient after MVRp. CONCLUSIONS: We concluded MVRe to be associated with lower operative and 5-year mortality and good postoperative outcomes compared to patients undergoing MVRp. Concomitant CAD was identified as one of the risk factors for increasing the in-hospital mortality rate. There was no significant difference in rehospitalisation over the follow-up period. MVRe should be the treatment of choice for severe MVR and should remain a central aspect in valve centers' treatment algorithms and quality measures.


Assuntos
Doença da Artéria Coronariana , Endocardite , Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Mitral , Humanos , Valva Mitral/cirurgia , Seguimentos , Estudos Retrospectivos , Pontuação de Propensão , Implante de Prótese de Valva Cardíaca/métodos , Resultado do Tratamento , Insuficiência da Valva Mitral/etiologia , Doença da Artéria Coronariana/cirurgia , Endocardite/cirurgia
13.
Circ Cardiovasc Imaging ; 16(1): e014652, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36649447

RESUMO

The use of positron emission tomography imaging with 18F-fluorodeoxyglucose in the diagnostic workup of patients with suspected prosthetic valve endocarditis and cardiac device infection (implantable electronic device and left ventricular assist device) is gaining momentum in clinical practice. However, in the absence of prospective randomized trials, guideline recommendations about 18F-fluorodeoxyglucose positron emission tomography in this setting are currently largely based on expert opinion. Measurement of aortic valve microcalcification occurring as a healing response to valvular inflammation using 18F-sodium fluoride positron emission tomography represents another promising clinical approach, which is associated with both the risk of native valve stenosis progression and bioprosthetic valve degeneration in research trials. In this review, we consider the role of molecular imaging in cardiac valvular diseases, including aortic stenosis and valvular endocarditis, as well as cardiac device infections.


Assuntos
Desfibriladores Implantáveis , Endocardite Bacteriana , Endocardite , Doenças das Valvas Cardíacas , Próteses Valvulares Cardíacas , Infecções Relacionadas à Prótese , Humanos , Fluordesoxiglucose F18 , Estudos Prospectivos , Próteses Valvulares Cardíacas/efeitos adversos , Endocardite/diagnóstico por imagem , Doenças das Valvas Cardíacas/diagnóstico por imagem , Imagem Molecular , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/terapia , Compostos Radiofarmacêuticos
15.
J Cardiovasc Med (Hagerstown) ; 24(2): 105-112, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36574285

RESUMO

BACKGROUND: Infective endocarditis (IE) is a significant disease characterized by high mortality and complications. The aim of this study was to evaluate the incidence/100 000 inhabitants and the in-hospital mortality/100 000 inhabitants of IE during the last 10 years in the province of Ravenna. METHODS AND RESULTS: We reviewed the public hospitals discharge database from January 2010 to December 2020 using the international classification of disease codification (ICD-9) for IE. We used the Italian national statistical institute (ISTAT) archive to estimate the number of Ravenna inhabitants/year. In 10 years, we identified a total of 407 patients with diagnosis of IE.The incidence of IE increased significantly from 6.29 cases/100 000 inhabitants in 2010 to 19.58 cases/100 000 inhabitants in 2020 ( P  < 0.001). Also, the in-hospital mortality from IE increased over the same number of years, from 1.8 deaths/100 000 inhabitants in 2010 to 4.4 deaths/100 000 inhabitants in 2020 ( P  < 0.001). The mortality rate (%) of IE over the years did not increase ( P = 0.565). Also, over the years there was no difference in the site of infection ( P  = 0.372), irrespective of the valve localization or type, native valve ( P  = 0.347) or prosthetic valve ( P  = 0.145). On logistic regression analysis, age was the only predictor of in-hospital mortality (odds ratio 1.045, 95% confidence interval: 1.015; 1.075, P  = 0.003). CONCLUSIONS: Ravenna-based data on IE showed increased disease incidence but unchanged mortality rate over 10 years of follow-up. Age remains the sole predictor of population-based mortality, irrespective of the nature of the valve, native or substitute, and the organism detected on microbiology.


Assuntos
Endocardite Bacteriana , Endocardite , Humanos , Incidência , Estudos Retrospectivos , Endocardite Bacteriana/microbiologia , Endocardite/diagnóstico , Endocardite/epidemiologia , Mortalidade Hospitalar , Fatores de Risco
16.
Curr Probl Cardiol ; 48(3): 101558, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36538998

RESUMO

Mitral annular calcification (MAC) is a chronic degenerative process often found incidentally on imaging. MAC is associated with elevated risk of atherosclerosis and stroke. The association between MAC and the risk of infective endocarditis (IE) is less well known. Therefore, we conducted this systematic review in order to understand the diagnosis, clinical outcomes, and management of IE associated with MAC. We conducted a systematic review of published data regarding MAC related IE in various databases until November 20, 2019. Case series and cohort studies were included. A total of 8 studies with a cohort of 113 patients were included. Mean age was 69 years with equal gender distribution (50% female). Hypertension (55.8%) was the most common comorbidity seen in this patient population. IE was diagnosed by either antemortem trans esophageal echocardiographic examination (76%) or post-mortem autopsy (24%). Staphylococcus aureus (47%) was the most common pathogen identified. MAC was adjudicated to be moderate-to-severe in 100% of identified cases, with 77.9% of cases presenting with distinct vegetation's. Twenty-six percent of patients (n = 29) underwent surgery. MAC may be associated with development of IE. Echocardiography is the most common non-invasive technique for diagnosis. Due to the difficulties associated with antemortem diagnosis, diagnosis is occasionally made on post-mortem examination. Neurologic complications are frequently encountered, and reported mortality is high in MAC associated IE.


Assuntos
Endocardite , Doenças das Valvas Cardíacas , Humanos , Feminino , Idoso , Masculino , Doenças das Valvas Cardíacas/epidemiologia , Valva Mitral/diagnóstico por imagem , Endocardite/complicações , Endocardite/diagnóstico , Endocardite/epidemiologia , Comorbidade , Ecocardiografia
17.
J Infect Chemother ; 29(3): 371-374, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36584815

RESUMO

The objective of this study was to evaluate the effectiveness of the recommended treatment for endovascular infections due to Coxiella burnetii. This single-center retrospective study was conducted in 13 patients with endovascular infection due to C. burnetii between January 2001 and December 2020 for a definite or possible endovascular infection due to C. burnetii with a minimum follow-up of 18 months post-infection. Clinical and biological data, including serology, blood and tissue PCR results, doxycycline and hydroxychloroquine assays were collected. Among the 13 patients, 11 had endocarditis (8 definite and 3 possible) and 2 had a vascular infection. At the time of diagnosis, fever was present in only 46% of cases. In case of endocarditis, 73% of patients had a pathological echocardiography. Biologically, the CRP level was low (52 mg/l ± 44). Autoimmune antibodies (antinuclear factor, neutrophil anticytoplasm) were present in 23% of patients. At the time of diagnosis, tissue PCR was very sensitive (100%) unlike blood or serum (29%). Blood levels of doxycycline and hydroxychloroquine were within expected values. Only one patient experienced treatment failure at two years, requiring surgery. For the 7 patients whose phase I IgG titres fell below 1/800, a minimum of 18 months of treatment was necessary. In the long term, the clinical and biological cure was 100% and 92% respectively, underlining the importance of monitoring the serum dosages of doxycycline and hydroxychloroquine. Given its sensitivity, tissue PCR could be added to the major Duke criteria.


Assuntos
Endocardite Bacteriana , Endocardite , Febre Q , Humanos , Doxiciclina/uso terapêutico , Antibacterianos/uso terapêutico , Febre Q/diagnóstico , Febre Q/tratamento farmacológico , Hidroxicloroquina/uso terapêutico , Seguimentos , Estudos Retrospectivos , Endocardite Bacteriana/tratamento farmacológico , Endocardite/tratamento farmacológico
18.
J Clin Lab Anal ; 37(1): e24816, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36535906

RESUMO

BACKGROUND: Aspergillus endocarditis (AE) is a rare fatal infection. The infection is often reported in patients with prosthetic heart valves, immunosuppressed, broad-spectrum antimicrobial use regimens, and drug abusers. METHODS: Herein, we report a rare case of native mitral valve AE in a 63-year-old man, with a probable COVID-19-associated invasive pulmonary aspergillosis nine months ago treated with antifungals. RESULTS: In the last admission, the lethargy, neurological deficit, and septic-embolic brain abscess in brain MRI led to suspicion of infective endocarditis. Transesophageal two-dimensional echocardiography and color Doppler flow velocity mapping showed a large highly mobile mass destroying leaflet and severe mitral regurgitation. The Surgical valve replacement is performed. The surgical valve replacement is performed. Direct microscopic examination and culture of the explanted and vegetative mass revealed Aspergillus section Fumiagati confirmed by molecular method. Despite the administration of voriconazole and transient improvement the patient expired. CONCLUSION: As AE is a late consequence of COVID-19-associated invasive pulmonary aspergillosis, therefore, long-term follow-up of invasive aspergillosis, and prompt diagnosis of surgical and systemic antifungal therapy treatment, are warranted to provide robust management.


Assuntos
COVID-19 , Endocardite , Aspergilose Pulmonar Invasiva , Masculino , Humanos , Pessoa de Meia-Idade , Aspergilose Pulmonar Invasiva/complicações , COVID-19/complicações , Endocardite/complicações , Endocardite/diagnóstico por imagem , Aspergillus , Voriconazol/uso terapêutico
19.
Catheter Cardiovasc Interv ; 101(1): 170-177, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36478377

RESUMO

INTRODUCTION: Transcatheter aortic valve implantation (TAVI) continues to be the most common modality of treating aortic stenosis in the United States. While infective endocarditis (IE) and its outcomes have been well documented after surgical aortic valve replacement, the incidence and outcomes of early IE after TAVI have not been well described. METHODS: All patients who underwent TAVI from 2012 through 2018 were identified using the National Readmission Database. Among them, patients who underwent TAVI at the index admission and readmitted within 90 days were included. Patients who died or had IE during the index admission were excluded. Clinical outcomes were compared between patients readmitted with IE (IE group) and those without (non-IE group). RESULTS: A total of 168,283 patients were readmitted to a hospital within 90 days after TAVI. The median age of the IE group and non-IE group were 81 and 82 years old, respectively (p = 0.21). Of those, 525 (0.3%) were readmitted with IE. The median time from TAVI to readmission was 20 days. During readmissions, 11.6% of the IE group died while only 3.15% of the non-IE group experienced death (p < 0.001). The most common causative organism of IE was enterococcus (22.1%). Multivariable analysis revealed that congestive heart failure, cerebrovascular disease, dialysis, concomitant valve disease, Medicaid, and discharge to a facility were independently associated with readmission with IE within 90 days. CONCLUSION: The incidence of readmission with IE is low after TAVI. However, the mortality was markedly high during readmissions. Surgical intervention was rarely performed for IE during the first admission. Enterococcus was the most common organism observed in IE after TAVI. DISCLOSURE: IS receives institutional research support from Abbott, Atricure, cryolife, and Medtronic. None related to this manuscript. CLINICAL TRIAL REGISTRATION: Not applicable.


Assuntos
Estenose da Valva Aórtica , Endocardite Bacteriana , Endocardite , Substituição da Valva Aórtica Transcateter , Humanos , Estados Unidos/epidemiologia , Idoso de 80 Anos ou mais , Substituição da Valva Aórtica Transcateter/efeitos adversos , Readmissão do Paciente , Resultado do Tratamento , Endocardite Bacteriana/cirurgia , Endocardite/diagnóstico , Endocardite/epidemiologia , Endocardite/etiologia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/complicações , Fatores de Risco
20.
J Stroke Cerebrovasc Dis ; 32(2): 106915, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36535133

RESUMO

OBJECTIVES: Large vessel occlusion (LVO)-related acute ischemic stroke due to infective endocarditis (IE) is a rare condition. At onset, most patients are severely ill, whereas on rare occasion, they develop mild neurological symptoms. As far as we are aware, this is the first report of IE related internal carotid artery (ICA) occlusion with low National Institutes of Health Stroke Scale (NIHSS) (<6) score treated with endovascular thrombectomy. CASE PRESENTATION: A 24-year-old woman had undergone dental treatment 3 weeks before and had a persistent low-grade fever for a week. She presented to the emergency department with a chief complaint of motor weakness of the right upper limb after waking up. She had only mild paralysis of the right upper limb (NIHSS score 1). Magnetic resonance imaging showed scattered infarcts in the left frontal lobe and cerebral angiography showed that the left ICA had been occluded immediately distal to its origin. The symptom disappeared after the occluded artery was completely recanalized by mechanical thrombectomy. On postoperative day 1, blood cultures were positive and echocardiography was performed, which revealed a verrucous mitral valve and a diagnosis of IE. On postoperative day 2, the patient underwent cardiac surgery for valve replacement. Thereafter, there was no recurrence of cerebral infarction, and the patient was discharged home on day 50 with a modified Rankin Scale 0. CONCLUSIONS: Early endovascular thrombectomy for low NIHSS score LVO due to IE resulted in a good treatment course. IE should be part of the differential diagnosis of LVO in the young patients.


Assuntos
Arteriopatias Oclusivas , Isquemia Encefálica , Endocardite , Procedimentos Endovasculares , AVC Isquêmico , Acidente Vascular Cerebral , Feminino , Humanos , Adulto Jovem , Adulto , Acidente Vascular Cerebral/etiologia , AVC Isquêmico/complicações , Resultado do Tratamento , Trombectomia/efeitos adversos , Arteriopatias Oclusivas/complicações , Endocardite/complicações , Estudos Retrospectivos , Isquemia Encefálica/complicações , Procedimentos Endovasculares/efeitos adversos
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