Infective endocarditis related to acute cholecystitis

A 30-year-old woman with a homologous dura-mater valve prosthesis developed infective endocarditis related to acute purulent cholecystitis occurring in chronic cholelithiasis. During anti-bacterial treatment refractory heart failure ensued which compelled replacement of the infected prosthesis. She died in the post-operative period. Autopsy revealed endocarditis on the implanted bioprosthesis, purulent cholecystitis and a gallbladder stone. It is warningly concluded that the surgical treatment of endocarditis was unsuccessful because of persistence of purulent cholecystitis that led to reinfection of the inserted prosthesis.

Campylobacter fetus endocarditis on a prosthetic heart valve

Campylobacter fetus infection in man is rare. Few cases of Campylobacter endocarditis have been described, and none have been associated with a prosthetic heart valve. We have reported a case of Campylobacter fetus ssp fetus on a prosthetic mitral valve in a 48-year-old woman who was treated successfully with penicillin and streptomycin (and later with gentamicin). Replacement of the prosthetic valve was done because of stenosis and vegetations. Pathologic examination showed vegetations on a calcified prosthesis, but no bacteria were seen.

Perioperative acute myocardial infarction after valve replacement

The incidence of fatal acute myocardial infarction (AMI) after valve replacement has decreased with use of cold potassium-induced cardioplegia. Despite this method of myocardial preservation, 12 of 662 consecutive patients submitted to valve replacement had this complication. This study retrospectively analyzes, in those 12 patients, the etiologic profile of fatal perioperative AMI, together with its morphologic aspects. The clinical picture in 11 patients was a refractory low cardiac output state. In only 3 cases was AMI diagnosis confirmed during life. Six patients either had a technical complication or a coronary embolus; in these patients AMI was localized in the vascular bed of a single occluded coronary artery, and its morphologic picture resembled that of usual AMI. The 6 other patients did not have a defined cause for AMI and coronary occlusion was not present. In 4 such patients, there was massive circumferential necrosis, mainly in the subendocardium; comparatively, there was a greater prevalence of hemorrhage, contraction bands and necrosis of the layer of subendocardial cells adjacent to the left ventricular cavity. The findings for this group suggest myocardial necrosis due to cell damage during cardiopulmonary bypass; no predisposing factor for perioperative AMI was identified.