201
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Utsunomiya H, Berdejo J, Kobayashi S, Mihara H, Itabashi Y, Shiota T. Evaluation of vegetation size and its relationship with septic pulmonary embolism in tricuspid valve infective endocarditis: A real time 3DTEE study. Echocardiography 2017; 34:549-556. [DOI: 10.1111/echo.13482] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Hiroto Utsunomiya
- Cedars-Sinai Heart Institute; Cedars-Sinai Medical Center; Los Angeles CA USA
| | - Javier Berdejo
- Cedars-Sinai Heart Institute; Cedars-Sinai Medical Center; Los Angeles CA USA
| | - Sayuki Kobayashi
- Cedars-Sinai Heart Institute; Cedars-Sinai Medical Center; Los Angeles CA USA
| | - Hirotsugu Mihara
- Cedars-Sinai Heart Institute; Cedars-Sinai Medical Center; Los Angeles CA USA
| | - Yuji Itabashi
- Cedars-Sinai Heart Institute; Cedars-Sinai Medical Center; Los Angeles CA USA
| | - Takahiro Shiota
- Cedars-Sinai Heart Institute; Cedars-Sinai Medical Center; Los Angeles CA USA
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202
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Davido B, Dinh A, Rouveix E, Crenn P, Hanslik T, Salomon J. [Splenic abscesses: From diagnosis to therapy]. Rev Med Interne 2017; 38:614-618. [PMID: 28196700 DOI: 10.1016/j.revmed.2016.12.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 08/23/2016] [Accepted: 12/15/2016] [Indexed: 11/30/2022]
Abstract
Splenic abscess is septic collection which occurs after haematogenous spread or local dissemination. Splenic abscess is an uncommon and rare condition, more frequently affecting male and immunocompromised patients. There are no guidelines regarding its diagnosis and management. Computed tomography (CT) scan is highly sensitive and specific (95% and 92%, respectively) in the diagnosis of splenic abscess. Diagnosis is based on blood cultures which are positive in 24 to 80% of cases. Bacterial growth culture of abscess after drainage is more efficient (50-80%) and can be performed after surgery or percutaneous drainage under imaging, including CT scan. Microorganisms involved are frequently enterobacteriaceae, gram-positive cocci and anaerobes. This particular ecology leads to an empiric broad-spectrum antibiotic therapy, with a variable duration, from 10days to more than one month. Management remains very close to the one applied in case of liver abscesses. The role of splenectomy in the prevention of recurrence remains controversial. We reviewed the literature regarding splenic abscesses, from diagnosis to therapy.
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Affiliation(s)
- B Davido
- Service de médecine interne, hôpital Ambroise-Paré, hôpitaux universitaires Paris Île-de-France Ouest, 92200 Boulogne-Billancourt, France; Service de maladies infectieuses, hôpital Raymond-Poincaré, hôpitaux universitaires Paris Île-de-France Ouest, 104, boulevard Raymond-Poincaré, 92380 Garches, France.
| | - A Dinh
- Service de médecine interne, hôpital Ambroise-Paré, hôpitaux universitaires Paris Île-de-France Ouest, 92200 Boulogne-Billancourt, France; Service de maladies infectieuses, hôpital Raymond-Poincaré, hôpitaux universitaires Paris Île-de-France Ouest, 104, boulevard Raymond-Poincaré, 92380 Garches, France
| | - E Rouveix
- Service de médecine interne, hôpital Ambroise-Paré, hôpitaux universitaires Paris Île-de-France Ouest, 92200 Boulogne-Billancourt, France
| | - P Crenn
- Service de maladies infectieuses, hôpital Raymond-Poincaré, hôpitaux universitaires Paris Île-de-France Ouest, 104, boulevard Raymond-Poincaré, 92380 Garches, France; Service de gastro-entérologie, nutrition transversale, hôpital Ambroise-Paré, hôpitaux universitaires Paris Île-de-France Ouest, 92200 Boulogne-Billancourt, France
| | - T Hanslik
- Service de médecine interne, hôpital Ambroise-Paré, hôpitaux universitaires Paris Île-de-France Ouest, 92200 Boulogne-Billancourt, France
| | - J Salomon
- Service de maladies infectieuses, hôpital Raymond-Poincaré, hôpitaux universitaires Paris Île-de-France Ouest, 104, boulevard Raymond-Poincaré, 92380 Garches, France
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203
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Pettersson GB, Coselli JS, Pettersson GB, Coselli JS, Hussain ST, Griffin B, Blackstone EH, Gordon SM, LeMaire SA, Woc-Colburn LE. 2016 The American Association for Thoracic Surgery (AATS) consensus guidelines: Surgical treatment of infective endocarditis: Executive summary. J Thorac Cardiovasc Surg 2017; 153:1241-1258.e29. [PMID: 28365016 DOI: 10.1016/j.jtcvs.2016.09.093] [Citation(s) in RCA: 260] [Impact Index Per Article: 37.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 09/12/2016] [Accepted: 09/16/2016] [Indexed: 12/23/2022]
Affiliation(s)
| | - Gösta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio.
| | - Joseph S Coselli
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Tex; Texas Heart Institute, Houston, Tex
| | | | - Gösta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Joseph S Coselli
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Tex; Texas Heart Institute, Houston, Tex
| | - Syed T Hussain
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Brian Griffin
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Steven M Gordon
- Department of Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Scott A LeMaire
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Tex; Texas Heart Institute, Houston, Tex
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204
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Thuny F, Habib G, Raoult D, Fournier PE. Endocarditis. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00051-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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205
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Celeste F, Muratori M, Mapelli M, Pepi M. The Evolving Role and Use of Echocardiography in the Evaluation of Cardiac Source of Embolism. J Cardiovasc Echogr 2017; 27:33-44. [PMID: 28465991 PMCID: PMC5412748 DOI: 10.4103/jcecho.jcecho_1_17] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
This report will review the role of echocardiography in the diagnosis of cardiac sources of embolism. Embolism of cardiac origin accounts for around 15%–30% of ischemic strokes. The diagnosis of a cardioembolic source of stroke is frequently uncertain and relies on the identification of a potential cardiac source of embolism in the absence of significant autochthonous cerebrovascular occlusive disease. Transthoracic and/or transesophageal echocardiography serves as a cornerstone in the evaluation, diagnosis, and management of these patients. This article reviews potential cardiac sources of embolism and discusses the role of echocardiography in clinical practice. Recommendations for the use of echocardiography in the diagnosis of cardiac sources of embolism are given including major and minor conditions associated with the risk of embolism.
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Affiliation(s)
- Fabrizio Celeste
- Department of Cardiovascular Sciences, Centro Cardiologico Monzino, IRCCS, University of Milan, 20138 Milan, Italy
| | - Manuela Muratori
- Department of Cardiovascular Sciences, Centro Cardiologico Monzino, IRCCS, University of Milan, 20138 Milan, Italy
| | - Massimo Mapelli
- Department of Cardiovascular Sciences, Centro Cardiologico Monzino, IRCCS, University of Milan, 20138 Milan, Italy
| | - Mauro Pepi
- Department of Cardiovascular Sciences, Centro Cardiologico Monzino, IRCCS, University of Milan, 20138 Milan, Italy
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206
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Rosa SA, Germano N, Santos A, Bento L. Aortic and tricuspid endocarditis in hemodialysis patient with systemic and pulmonary embolism. Rev Bras Ter Intensiva 2016; 27:185-9. [PMID: 26340160 PMCID: PMC4489788 DOI: 10.5935/0103-507x.20150031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 04/24/2015] [Indexed: 11/20/2022] Open
Abstract
This is a case report of a 43-year-old Caucasian male with end-stage renal disease
being treated with hemodialysis and infective endocarditis in the aortic and
tricuspid valves. The clinical presentation was dominated by neurologic impairment
with cerebral embolism and hemorrhagic components. A thoracoabdominal computerized
tomography scan revealed septic pulmonary embolus. The patient underwent empirical
antibiotherapy with ceftriaxone, gentamicin and vancomycin, and the therapy was
changed to flucloxacilin and gentamicin after the isolation of S.
aureus in blood cultures. The multidisciplinary team determined that the
patient should undergo valve replacement after the stabilization of the intracranial
hemorrhage; however, on the 8th day of hospitalization, the patient
entered cardiac arrest due to a massive septic pulmonary embolism and died. Despite
the risk of aggravation of the hemorrhagic cerebral lesion, early surgical
intervention should be considered in high-risk patients.
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Affiliation(s)
- Silvia Aguiar Rosa
- Departamento de Cardiologia, Hospitalar de Lisboa Central, Lisboa, Portugal
| | - Nuno Germano
- Unidade de Urgência Médica, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - Ana Santos
- Unidade de Urgência Médica, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - Luis Bento
- Unidade de Urgência Médica, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
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207
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Abstract
Complications involving the central and peripheral nervous system are frequently encountered in critically ill patients. All components of the neuraxis can be involved including the brain, spinal cord, peripheral nerves, neuromuscular junction, and muscles. Neurologic complications adversely impact outcome and length of stay. These complications can be related to underlying critical illness, pre-existing comorbid conditions, and commonly used and life-saving procedures and medications. Familiarity with the myriad neurologic complications that occur in the intensive care unit can facilitate their timely recognition and treatment. Additionally, awareness of treatment-related neurologic complications may inform decision-making, mitigate risk, and improve outcomes.
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Affiliation(s)
- Clio Rubinos
- Department of Neurology, Loyola University Chicago-Stritch School of Medicine, Maywood, IL, 60153, USA
| | - Sean Ruland
- Department of Neurology, Loyola University Chicago-Stritch School of Medicine, Maywood, IL, 60153, USA.
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208
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Oliver L, Lepeule R, Moussafeur A, Fiore A, Lim P, Ternacle J. Early surgery in infective endocarditis: Why should we wait? Arch Cardiovasc Dis 2016; 109:651-654. [PMID: 27887810 DOI: 10.1016/j.acvd.2016.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 10/14/2016] [Accepted: 10/14/2016] [Indexed: 02/02/2023]
Affiliation(s)
- Leopold Oliver
- Department of Cardiovascular Medicine, Henri-Mondor University Hospital, AP-HP, Créteil, France; SOS Endocardites Unit, Henri-Mondor University Hospital, AP-HP, Créteil, France
| | - Raphael Lepeule
- SOS Endocardites Unit, Henri-Mondor University Hospital, AP-HP, Créteil, France; Department of Infectious Diseases, Henri-Mondor University Hospital, AP-HP, Créteil, France
| | - Amina Moussafeur
- Department of Cardiovascular Medicine, Henri-Mondor University Hospital, AP-HP, Créteil, France; SOS Endocardites Unit, Henri-Mondor University Hospital, AP-HP, Créteil, France
| | - Antonio Fiore
- SOS Endocardites Unit, Henri-Mondor University Hospital, AP-HP, Créteil, France; Department of Cardiac Surgery, Henri-Mondor University Hospital, AP-HP, Créteil, France
| | - Pascal Lim
- Department of Cardiovascular Medicine, Henri-Mondor University Hospital, AP-HP, Créteil, France; SOS Endocardites Unit, Henri-Mondor University Hospital, AP-HP, Créteil, France
| | - Julien Ternacle
- Department of Cardiovascular Medicine, Henri-Mondor University Hospital, AP-HP, Créteil, France; SOS Endocardites Unit, Henri-Mondor University Hospital, AP-HP, Créteil, France.
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209
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Saric M, Armour AC, Arnaout MS, Chaudhry FA, Grimm RA, Kronzon I, Landeck BF, Maganti K, Michelena HI, Tolstrup K. Guidelines for the Use of Echocardiography in the Evaluation of a Cardiac Source of Embolism. J Am Soc Echocardiogr 2016; 29:1-42. [PMID: 26765302 DOI: 10.1016/j.echo.2015.09.011] [Citation(s) in RCA: 225] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Embolism from the heart or the thoracic aorta often leads to clinically significant morbidity and mortality due to transient ischemic attack, stroke or occlusion of peripheral arteries. Transthoracic and transesophageal echocardiography are the key diagnostic modalities for evaluation, diagnosis, and management of stroke, systemic and pulmonary embolism. This document provides comprehensive American Society of Echocardiography guidelines on the use of echocardiography for evaluation of cardiac sources of embolism. It describes general mechanisms of stroke and systemic embolism; the specific role of cardiac and aortic sources in stroke, and systemic and pulmonary embolism; the role of echocardiography in evaluation, diagnosis, and management of cardiac and aortic sources of emboli including the incremental value of contrast and 3D echocardiography; and a brief description of alternative imaging techniques and their role in the evaluation of cardiac sources of emboli. Specific guidelines are provided for each category of embolic sources including the left atrium and left atrial appendage, left ventricle, heart valves, cardiac tumors, and thoracic aorta. In addition, there are recommendation regarding pulmonary embolism, and embolism related to cardiovascular surgery and percutaneous procedures. The guidelines also include a dedicated section on cardiac sources of embolism in pediatric populations.
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Affiliation(s)
- Muhamed Saric
- New York University Langone Medical Center, New York, New York
| | | | - M Samir Arnaout
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Farooq A Chaudhry
- Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Richard A Grimm
- Learner College of Medicine, Cleveland Clinic, Cleveland, Ohio
| | | | | | | | | | - Kirsten Tolstrup
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico
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210
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What does acute onset means in the context of Staphylococcus aureus infective endocarditis? Description of a hyperacute infective endocarditis. Presse Med 2016; 45:933-935. [DOI: 10.1016/j.lpm.2016.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 04/27/2016] [Accepted: 05/24/2016] [Indexed: 11/21/2022] Open
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211
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Georgescu AM, Azamfirei L, Szalman K, Szekely E. Fatal endocarditis with methicilin-sensible Staphylococcus aureus and major complications: rhabdomyolysis, pericarditis, and intracerebral hematoma: A case report and review of the literature. Medicine (Baltimore) 2016; 95:e5125. [PMID: 27741135 PMCID: PMC5072962 DOI: 10.1097/md.0000000000005125] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Over the last decades Staphylococcus aureus (SA) has become the dominant etiology of native valve infective endocarditis, with the community-acquired methicillin-sensible Staphylococcus aureus (CA-MSSA) strains being the prevailing type. CASE We report here a case of extremely severe CA-MSSA aortic valve acute endocarditis associated with persistent Staphylococcus aureus bacteremia (SAB) in a previously healthy man and include a literature review.The patient developed severe and rare complications (purpura, purulent pericarditis, intracerebral hematoma, and rhabdomyolysis) through systemic embolism; they required drainage of pericardial empyema and cerebral hematoma, the latter eventually caused a fatal outcome. The strains recovered from sequential blood culture sets and pericardial fluid were MSSA negative for genes encoding for staphylococcal toxic shock syndrome toxin (TSST)-1 and Panton-Valentine leukocidin. C, G, and I enterotoxin genes were detected. CONCLUSIONS This case with unusually severe evolution underlines the limited ability of vancomycin to control some MSSA infections, possibly due to potential involvement of SA virulence factors, hence the importance of clinical vigilance for community SAB cases.
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Affiliation(s)
| | - Leonard Azamfirei
- Department of Anesthesiology and Intensive Care
- Correspondence: Leonard Azamfirei, Department of Anesthesiology and Intensive Care, University of Medicine and Pharmacy Tirgu Mures, Gh. Marinescu 38, 54300, Romania (e-mail: )
| | | | - Edit Szekely
- Department of Microbiology, University of Medicine and Pharmacy Tirgu Mures, Romania
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212
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Starosta RT, Rivero R, de Oliveira FH, Lopes E, Cerski MR. Misdiagnosis of Streptococcus gallolyticus endocarditis. AUTOPSY AND CASE REPORTS 2016; 6:29-33. [PMID: 27818956 PMCID: PMC5087981 DOI: 10.4322/acr.2016.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 07/17/2016] [Indexed: 11/23/2022] Open
Abstract
Death certificate inaccuracy is of major concern both in the public health domain and in individual health care, since it may yield untruthful data on the incidence, prevalence, and lethality of medical entities, and may hamper prophylactic measures among those who share, with the deceased, the common genetic, environmental, or behavioral risk factors. An effective way to settle this haziness relies on the increase of autopsy performance, increasing manifold the exactitude as well as facing surprising diagnoses. In this report, the authors present the case of a middle-aged woman who sought medical care because of back pain accompanied by weight loss. She died suddenly and unexpectedly in the Emergency Room. In this case, due to the unusual clinical presentation and the patient's unexpected death, the causa mortis would not have been elucidated if the autopsy had not been undertaken.
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Affiliation(s)
| | - Raquel Rivero
- Service of Surgical Pathology - Hospital de Clínicas de Porto Alegre - Universidade Federal do Rio Grande do Sul, Porto Alegre/RS - Brazil
| | - Francine Hehn de Oliveira
- Service of Surgical Pathology - Hospital de Clínicas de Porto Alegre - Universidade Federal do Rio Grande do Sul, Porto Alegre/RS - Brazil
| | - Eron Lopes
- Service of Surgical Pathology - Hospital de Clínicas de Porto Alegre - Universidade Federal do Rio Grande do Sul, Porto Alegre/RS - Brazil
| | - Marcelle Reesink Cerski
- Service of Surgical Pathology - Hospital de Clínicas de Porto Alegre - Universidade Federal do Rio Grande do Sul, Porto Alegre/RS - Brazil
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213
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Delahaye F. [Which patients with infective endocarditis require emergency surgery?]. Presse Med 2016; 45:926-932. [PMID: 27687628 DOI: 10.1016/j.lpm.2016.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 08/22/2016] [Indexed: 11/18/2022] Open
Abstract
Half of patients with infectious endocarditis have surgery during the active phase of infective endocarditis (before the end of antibiotic therapy). The American Heart Association and the European Society of Cardiology, independently from each other, have published guidelines in September 2015. As regards surgical indications, these guidelines are similar. The surgical indication must be a common decision of a multidisciplinary team of experts in cardiology, cardiac surgery, imaging and infectious diseases. The main indications are heart failure, non-infectious process control and prevention of embolisms.
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Affiliation(s)
- François Delahaye
- Hospices civils de Lyon, université Claude Bernard Lyon 1, EA 7425 : qualité sécurité performance en santé, 69000 Lyon, France.
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214
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Barreto Cortes M, Teixeira V, Fernandes SR, Rego F. Haemophilus parainfluenzae endocarditis with systemic embolisation following maxillary sinusitis. BMJ Case Rep 2016; 2016:bcr-2016-216473. [PMID: 27599807 DOI: 10.1136/bcr-2016-216473] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The authors present a case of a man with Haemophilus parainfluenzae endocarditis complicated with embolisation to the central nervous system. The patient had no evidence of endocarditis by transoesophageal and transthoracic echocardiograms at baseline, but shortly after developed large mitral valve vegetations with valve rupture. The case highlights how rapidly structural valve damage can ensue despite good clinical and laboratorial antibiotic response.
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Affiliation(s)
| | - Vitor Teixeira
- Serviço de Reumatologia e Doenças ósseas metabólicas, Hospital de Santa Maria, Lisbon, Portugal
| | | | - Fernanda Rego
- Serviço de Medicina Interna, Hospital de Santa Maria, Lisbon, Portugal
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215
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Yu Z, Fan B, Wu H, Wang X, Li C, Xu R, Su Y, Ge J. Multiple systemic embolism in infective endocarditis underlying in Barlow's disease. BMC Infect Dis 2016; 16:403. [PMID: 27514369 PMCID: PMC4982419 DOI: 10.1186/s12879-016-1726-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 07/20/2016] [Indexed: 12/16/2022] Open
Abstract
Background Systemic embolism, especially septic embolism, is a severe complication of infective endocarditis (IE). However, concurrent embolism to the brain, coronary arteries, and spleen is very rare. Because of the risk of hemorrhage or visceral rupture, anticoagulants are recommended only if an indication is present, e.g. prosthetic valve. Antiplatelet therapy in IE is controversial, but theoretically, this therapy has the potential to prevent and treat thrombosis and embolism in IE. Unfortunately, clinical trial results have been inconclusive. Case presentation We describe a previously healthy 50-year-old man who presented with dysarthria secondary to bacterial endocarditis with multiple cerebral, coronary, splenic, and peripheral emboli; antibiotic therapy contributed to the multiple emboli. Emergency splenectomy was performed, with subsequent mitral valve repair. Pathological examination confirmed mucoid degeneration and mitral valve prolapse (Barlow’s disease) as the underlying etiology of the endocardial lesion. Continuous antibiotics were prescribed, postoperatively. Transthoracic echocardiography at 1.5, 3, and 6 months after the onset of his illness showed no severe regurgitation, and there was no respiratory distress, fever, or lethargy during follow-up. Conclusions Although antibiotic use in IE carries a risk of septic embolism, these drugs have bactericidal and antithrombotic benefits. It is important to consider that negative blood culture and symptom resolution do not confirm complete elimination of bacteria. However, vegetation size and Staphylococcus aureus infection accurately predict embolization. It is also important to consider that bacteria can be segregated from the microbicide when embedded in platelets and fibrin. Therefore, antimicrobial therapy with concurrent antiplatelet therapy should be considered carefully. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1726-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ziqing Yu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China.,Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
| | - Bing Fan
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Hongyi Wu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Xiangfei Wang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Chenguang Li
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Rende Xu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Yangang Su
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China.
| | - Junbo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China.
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216
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217
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A Meta-Analysis of Early versus Delayed Surgery for Valvular Infective Endocarditis Complicated by Embolic Ischemic Stroke. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016; 11:187-92. [DOI: 10.1097/imi.0000000000000271] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective An embolic ischemic stroke occurs in 10% to 40% of patients with valvular infective endocarditis (IE) and confers significant morbidity. The optimal timing of valve surgery in this population is not well defined. Methods With the use of PubMed, EMBASE, Ovid, and Cochrane databases, a systematic review identified 14 studies through October 2015 that compared early versus delayed surgery for valvular IE complicated by an ischemic stroke. Early surgery was defined as 3 days or less in one, 7 days or less in eight, and 14 days or less in five studies. Risk ratios (RRs) were calculated by the Mantel-Haenszel method under a fixed- or random-effects model, for the outcomes of perioperative stroke, operative mortality, and 1-year survival. Results A total of 833 patients (early surgery, 330; delayed surgery, 503) were included. The majority of operations were for aortic and/or mitral valve IE, with prosthetic valve IE present in 0% to 60%. Infection with Staphylococcus aureus ranged from 19% to 66%, and heart failure prevalence at the time of operation was 24% to 66%. Early surgery was associated with an increased risk of operative mortality (RR, 1.72; 95% confidence interval [CI], 1.27–2.34; P = 0.0005), which was significant regardless of surgery within the first 7 days (RR, 2.19; 95% CI, 1.45–3.31; P = 0.0002) or 14 days (RR, 1.72; 95% CI, 1.12–2.64; P = 0.01) after stroke. Surgical timing did not affect the risk of perioperative ischemic or hemorrhagic stroke or 1-year survival. Conclusions In patients with valvular IE complicated by ischemic stroke, early surgery is associated with an increased risk of operative mortality, with no observed benefit in 1-year survival.
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Mihos CG, Pineda AM, Santana O. A Meta-Analysis of Early versus Delayed Surgery for Valvular Infective Endocarditis Complicated by Embolic Ischemic Stroke. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016. [DOI: 10.1177/155698451601100306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Christos G. Mihos
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Andres M. Pineda
- Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL USA
| | - Orlando Santana
- Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL USA
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219
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Diab M, Guenther A, Sponholz C, Lehmann T, Faerber G, Matz A, Franz M, Witte OW, Pletz MW, Doenst T. Pre-operative stroke and neurological disability do not independently affect short- and long-term mortality in infective endocarditis patients. Clin Res Cardiol 2016; 105:847-57. [PMID: 27122133 DOI: 10.1007/s00392-016-0993-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 04/22/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Infective endocarditis (IE) is still associated with high morbidity and mortality. The impact of pre-operative stroke on mortality and long-term survival is controversial. In addition, data on the severity of neurological disability due to pre-operative stroke are scarce. We analysed the impact of pre-operative stroke and the severity of its related neurological disability on short- and long-term outcome. METHODS We retrospectively reviewed our data from patients operated for left-sided IE between 01/2007 and 04/2013. We performed univariate (Chi-Square and independent samples t test) and multivariate analyses. RESULTS Among 308 consecutive patients who underwent cardiac surgery for left-sided IE, pre-operative stroke was present in 87 (28.2 %) patients. Patients with pre-operative stroke had a higher pre-operative risk profile than patient without it: higher Charlson comorbidity index (8.1 ± 2.6 vs. 6.6 ± 3.3) and higher incidence of Staphylococcus aureus infection (43 vs. 17 %) and septic shock (37 vs. 19 %). In-hospital mortality was equal but 5-year survival was significantly worse with pre-operative stroke (33.1 % vs. 45 %, p = 0.006). 5-year survival was worst in patients with severe neurological disability compared to mild disability (19.0 vs. 0.58 %, p = 0.002). However, neither pre-operative stroke nor the degree of neurological disability appeared as an independent risk factor for short or long-term mortality by multivariate analysis. CONCLUSIONS Pre-operative stroke and the severity of neurological disability do not independently affect short- and long-term mortality in patients with infective endocarditis. It appears that patients with pre-operative stroke present with a generally higher risk profile. This information may substantially affect decision-making.
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Affiliation(s)
- Mahmoud Diab
- Department of Cardiothoracic Surgery, Jena University Hospital-Friedrich Schiller University of Jena, Erlanger Allee 101, 07747, Jena, Germany.,Department of Cardiothoracic Surgery, Cairo University, Cairo, Egypt
| | - Albrecht Guenther
- Department of Neurology, Jena University Hospital-Friedrich Schiller University of Jena, Jena, Germany
| | - Christoph Sponholz
- Department of Anaesthesiology and Critical Care Medicine, Jena University Hospital-Friedrich Schiller University of Jena, Jena, Germany
| | - Thomas Lehmann
- Center of Clinical Studies, Department of Cardiology, Jena University Hospital-Friedrich Schiller University of Jena, Jena, Germany
| | - Gloria Faerber
- Department of Cardiothoracic Surgery, Jena University Hospital-Friedrich Schiller University of Jena, Erlanger Allee 101, 07747, Jena, Germany
| | - Anna Matz
- Department of Cardiothoracic Surgery, Jena University Hospital-Friedrich Schiller University of Jena, Erlanger Allee 101, 07747, Jena, Germany
| | - Marcus Franz
- Center for Infectious Diseases and Infection Control, Jena University Hospital-Friedrich Schiller University of Jena, Jena, Germany
| | - Otto W Witte
- Department of Neurology, Jena University Hospital-Friedrich Schiller University of Jena, Jena, Germany
| | - Mathias W Pletz
- Center for Infectious Diseases and Infection Control, Jena University Hospital-Friedrich Schiller University of Jena, Jena, Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital-Friedrich Schiller University of Jena, Erlanger Allee 101, 07747, Jena, Germany.
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220
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Pericart L, Fauchier L, Bourguignon T, Bernard L, Angoulvant D, Delahaye F, Babuty D, Bernard A. Long-Term Outcome and Valve Surgery for Infective Endocarditis in the Systematic Analysis of a Community Study. Ann Thorac Surg 2016; 102:496-504. [PMID: 27131900 DOI: 10.1016/j.athoracsur.2016.02.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 02/02/2016] [Accepted: 02/02/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Information on the long-term prognosis of patients with infective endocarditis (IE) and valve surgical procedures is scarce, and most analyses are based on registries. This study described outcomes and predictors of mortality in a cohort of consecutive patients with IE with a long-term follow-up. METHODS A total of 616 of patients with IE seen in an academic institution between 1990 and 2012 were identified and followed. The mean follow-up period was 4.8 ± 5.7 years (median, 2.6 years). RESULTS Cardiac surgical procedures were performed in 47% of the patients, among whom 77% had surgical procedures in the first 6 months. Six-month and long-term (≥6 month) mortality rates were 15% and 40%, respectively. Older age, male sex, infection in a mechanical valve, Staphylococcus aureus infection, presence of vegetation, stroke, and atrioventricular block were independent predictors of mortality, whereas Streptococcus infection was independently associated with a better prognosis. Valve surgical procedures were independently associated with a decrease in mortality: hazard ratio (HR): 0.38; 95% confidence interval (CI): 0.26 to 0.56 for surgical treatment within 45 days; HR 0.36; 95% CI: 0.22 to 0.61 for surgical treatment between 45 and 180 days; and HR: 0.42; 95% CI: 0.25 to 0.73 for surgical treatment beyond 6 months. Decrease in mortality with valve surgical procedures was found in the two subgroups of patients with definite IE (adjusted HR: 0.36; 95% CI: 0.24 to 0.54; p < 0.0001) and in those with possible IE (HR: 0.40; 95% CI: 0.24 to 0.67; p = 0.0005). CONCLUSIONS In unselected patients with IE, prognostic factors for long-term mortality were consistent with those identified in previous studies for short-term mortality. These results confirm the apparent benefit associated with valve surgical procedures on long-term prognosis.
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Affiliation(s)
- Lauriane Pericart
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France; Faculté de Médecine, Université François Rabelais, Tours, France
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France; Faculté de Médecine, Université François Rabelais, Tours, France.
| | - Thierry Bourguignon
- Faculté de Médecine, Université François Rabelais, Tours, France; Service de Chirurgie Cardiaque et Thoracique, Centre Hospitalier Universitaire Trousseau, Tours, France
| | - Louis Bernard
- Faculté de Médecine, Université François Rabelais, Tours, France; Service de Maladies Infectieuses, Centre Hospitalier Universitaire Bretonneau, Tours, France
| | - Denis Angoulvant
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France; Faculté de Médecine, Université François Rabelais, Tours, France
| | - François Delahaye
- Service de Cardiologie, Hospices Civils de Lyon, Université Claude-Bernard Lyon I, Lyon, France
| | - Dominique Babuty
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France; Faculté de Médecine, Université François Rabelais, Tours, France
| | - Anne Bernard
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France; Faculté de Médecine, Université François Rabelais, Tours, France
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221
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Abdallah L, Remadi JP, Habib G, Salaun E, Casalta JP, Tribouilloy C. Long-term prognosis of left-sided native-valve Staphylococcus aureus endocarditis. Arch Cardiovasc Dis 2016; 109:260-7. [DOI: 10.1016/j.acvd.2015.11.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 10/06/2015] [Accepted: 11/11/2015] [Indexed: 10/22/2022]
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222
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Okita Y, Minakata K, Yasuno S, Uozumi R, Sato T, Ueshima K, Konishi H, Morita N, Harada M, Kobayashi J, Suehiro S, Kawahito K, Okabayashi H, Takanashi S, Ueda Y, Usui A, Imoto K, Tanaka H, Okamura Y, Sakata R, Yaku H, Tanemoto K, Imoto Y, Hashimoto K, Bando K. Optimal timing of surgery for active infective endocarditis with cerebral complications: a Japanese multicentre study. Eur J Cardiothorac Surg 2016; 50:374-82. [DOI: 10.1093/ejcts/ezw035] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 01/25/2016] [Indexed: 12/22/2022] Open
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Khafaga M, Kresoja KP, Urlesberger B, Knez I, Klaritsch P, Lumenta DB, Krause R, von Lewinski D. Staphylococcus lugdunensis Endocarditis in a 35-Year-Old Woman in Her 24th Week of Pregnancy. Case Rep Obstet Gynecol 2016; 2016:7030382. [PMID: 27051543 PMCID: PMC4804077 DOI: 10.1155/2016/7030382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 02/03/2016] [Accepted: 02/11/2016] [Indexed: 11/30/2022] Open
Abstract
Background. Infective endocarditis is associated with considerable morbidity and mortality. Guidelines addressing prophylaxis and management of infective endocarditis do not extensively deal with concomitant pregnancy, and case reports on infective endocarditis are scarce. This is the first published report of infective endocarditis by Staphylococcus lugdunensis in a pregnant woman. Case Presentation. We report a single case of a 35-year-old woman in her 24th week of pregnancy who was admitted to our intensive care unit with fever and suspected infectious endocarditis. Blood culture detected Staphylococcus lugdunensis. A vegetation and severe mitral regurgitation due to complete destruction of the valve confirmed the diagnosis. An interdisciplinary panel of cardiologists, maternal-fetal medicine specialists, cardiac and plastic surgeons, infectiologists, anesthesiologists, and neonatologists was formed to determine the best therapeutic strategy. Conclusions. Timing and indications for surgical intervention to prevent embolic complications in infective endocarditis remain controversial. This original case report illustrates how managing infective endocarditis by Staphylococcus lugdunensis particularly in the 24th week of pregnancy can represent a therapeutic challenge to a broad section of specialties across medicine. Critical cases like this require a thorough weighing of risks and benefits followed by swift action to protect the mother and her unborn child.
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Affiliation(s)
- Mounir Khafaga
- Department of Cardiology, Medical University of Graz, 8036 Graz, Austria
| | | | - Berndt Urlesberger
- Division of Neonatology, Department of Paediatrics, Medical University of Graz, 8036 Graz, Austria
| | - Igor Knez
- Division of Cardiac Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria
| | - Philipp Klaritsch
- Department of Obstetrics and Gynecology, Medical University of Graz, 8036 Graz, Austria
| | - David Benjamin Lumenta
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria
| | - Robert Krause
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Dirk von Lewinski
- Department of Cardiology, Medical University of Graz, 8036 Graz, Austria
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224
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Mizokami K, Gotoh M, Mitsui Y, Yoshikawa I, Uryu T, Shirahama M, Okawa T, Higuchi F, Shiba N. Infective Endocarditis Presenting as Right Shoulder Pain: A Case Report. Kurume Med J 2016; 62:33-36. [PMID: 26935440 DOI: 10.2739/kurumemedj.ms64007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Although cases of referred shoulder pain due to ischemic heart disease have been well documented, to our knowledge no reports on infective endocarditis accompanied by referred right shoulder pain have been published. A 43-year-old Japanese man presented with severe right shoulder pain and a body temperature of 38°C.Blood tests showed inflammation and liver dysfunction, although magnetic resonance imaging did not indicate septic shoulder arthritis. However, contrast-enhanced computed tomography showed renal, splenic, and hepatic infarctions. Moreover, a labile vegetation was detected on an echocardiogram. The patient was diagnosed with infective endocarditis and antibiotics were administered intravenously. Infective endocarditis is a serious condition that can result in complications if it is not diagnosed and treated at an early stage. Therefore, in cases with referred shoulder pain, physicians should carefully consider the presence of internal diseases that may cause this condition, as in the present case.
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Affiliation(s)
- Kenji Mizokami
- Department of Orthopedic Surgery, Kurume University Medical Center
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225
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Neto S, Flores JC, Figueiredo EG, Caldas JGP, Teixeira MJ. Mycotic Aneurysm Treated with Aneurysm Trapping. Case Report. J Neurol Surg Rep 2016; 77:e013-6. [PMID: 26929896 PMCID: PMC4726378 DOI: 10.1055/s-0035-1567864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 09/26/2015] [Indexed: 10/24/2022] Open
Abstract
The authors describe a rare case of mycotic aneurysm (MA) associated with subarachnoid hemorrhage treated with aneurysm trapping. The literature on management and the surgical techniques are controversial due to lack of randomize trials.
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Affiliation(s)
- Sérgio Neto
- Division of Neurosurgery, University of Sao Paulo Medical School, Sao Paulo, Sao Paulo, Brazil
| | - Juan Castro Flores
- Division of Neurosurgery, University of Sao Paulo Medical School, Sao Paulo, Sao Paulo, Brazil
| | | | - José Guilherme Pereira Caldas
- Division of Interventional Radiology, Hospital das Clinicas, University of São Paulo Medical School, Sao Paulo, Sao Paulo, Brazil
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226
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Indications de chirurgie en urgence des valvulopathies mitrales et aortiques. MEDECINE INTENSIVE REANIMATION 2016. [DOI: 10.1007/s13546-016-1173-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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227
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Abstract
Infective endocarditis occurs worldwide, and is defined by infection of a native or prosthetic heart valve, the endocardial surface, or an indwelling cardiac device. The causes and epidemiology of the disease have evolved in recent decades with a doubling of the average patient age and an increased prevalence in patients with indwelling cardiac devices. The microbiology of the disease has also changed, and staphylococci, most often associated with health-care contact and invasive procedures, have overtaken streptococci as the most common cause of the disease. Although novel diagnostic and therapeutic strategies have emerged, 1 year mortality has not improved and remains at 30%, which is worse than for many cancers. Logistical barriers and an absence of randomised trials hinder clinical management, and longstanding controversies such as use of antibiotic prophylaxis remain unresolved. In this Seminar, we discuss clinical practice, controversies, and strategies needed to target this potentially devastating disease.
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Affiliation(s)
- Thomas J Cahill
- Department of Cardiology, Oxford University Hospitals, Oxford, UK
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228
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Diab M, Guenther A, Scheffel P, Sponholz C, Lehmann T, Hedderich J, Faerber G, Brunkhorst F, Pletz MW, Doenst T. Can radiological characteristics of preoperative cerebral lesions predict postoperative intracranial haemorrhage in endocarditis patients? Eur J Cardiothorac Surg 2016; 49:e119-26. [PMID: 26888461 DOI: 10.1093/ejcts/ezw014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 12/22/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Infective endocarditis (IE) is associated with high mortality (20-40%) and neurological complications (20-50%). Postoperative intracranial haemorrhage (ICH) is a feared complication especially in patients with preoperative cerebral infarcts. The aim of this study was to determine the radiological characteristics of cerebral lesions that could predict the occurrence of postoperative ICH in IE patients. METHODS We retrospectively reviewed all charts, brain imaging and follow-up data from patients operated for left-sided endocarditis between January 2007 and April 2013. RESULTS A total of 308 patients (age 62.0 ± 13.9) underwent surgery for IE. Preoperative cerebrovascular complications were present in 122 patients (39.6%), representing stroke in 87, silent cerebral infarctions in 31 patients and transient ischaemic attacks in 4 patients. Among 118 patients with cerebral lesions, the aetiological classification of the lesions was ischaemic in 63.6%, ischaemic with haemorrhagic transformation (HT) in 17.8%, ischaemic with concomitant microbleeds in 16.1% and intracerebral bleeding in 2.5%. Postoperative ICH occurred in 17 patients and its incidence was slightly higher in patients with preoperative cerebral infarcts compared with those without preoperative cerebral infarcts [7.6 vs 4.2%, respectively, odds ratio (OR) 1.88, 95% confidence interval (CI) 0.70-5.02, P = 0.21]. However, the difference was not statistically significant. Similarly, the incidence of postoperative ICH was higher in cases of HT of ischaemic infarcts than in cases of ischaemic infarcts not complicated with HT (19.0 vs 5.3%). However, the difference was not statistically significant (P = 0.24). The radiological pattern of preoperative cerebral lesions was single in 35.6% and multiple in 60.0% of cases. Multiple cerebral lesions were associated with a non-significantly lower incidence of postoperative ICH than single lesions (5.6 vs 11.9%, respectively, OR: 0.44, CI: 0.11-1.73, P = 0.29). CONCLUSIONS The results suggest that the incidence of postoperative ICH in IE patients was slightly higher in the presence of preoperative cerebral infarcts. In addition, preoperative cerebral ischaemic infarcts complicated with HT tended to have a higher incidence of postoperative ICH than those not complicated with HT. However, the difference was not statistically significant. Multiple preoperative cerebral infarcts were not associated with higher incidence of postoperative ICH compared with single cerebral infarcts.
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Affiliation(s)
- Mahmoud Diab
- Department of Cardiothoracic Surgery, Jena University Hospital - Friedrich Schiller University of Jena, Jena, Germany Department of Cardiothoracic Surgery, Cairo University, Cairo, Egypt
| | - Albrecht Guenther
- Department of Neurology, Jena University Hospital - Friedrich Schiller University of Jena, Jena, Germany
| | - Philipp Scheffel
- Department of Anaesthesiology and Critical Care Medicine, Jena University Hospital - Friedrich Schiller University of Jena, Jena, Germany
| | - Christoph Sponholz
- Department of Anaesthesiology and Critical Care Medicine, Jena University Hospital - Friedrich Schiller University of Jena, Jena, Germany
| | - Thomas Lehmann
- Center of Clinical Studies, Jena University Hospital - Friedrich Schiller University of Jena, Jena, Germany
| | - Johannes Hedderich
- Department of Cardiothoracic Surgery, Jena University Hospital - Friedrich Schiller University of Jena, Jena, Germany
| | - Gloria Faerber
- Department of Cardiothoracic Surgery, Jena University Hospital - Friedrich Schiller University of Jena, Jena, Germany
| | - Frank Brunkhorst
- Center of Clinical Studies, Jena University Hospital - Friedrich Schiller University of Jena, Jena, Germany
| | - Mathias W Pletz
- Center for Infectious Diseases and Infection Control, Jena University Hospital - Friedrich Schiller University of Jena, Jena, Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital - Friedrich Schiller University of Jena, Jena, Germany
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229
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Stansfield WE. Multidisciplinary risk assessment and treatment: The evolution of triage. J Thorac Cardiovasc Surg 2016; 151:e64-5. [PMID: 26774169 DOI: 10.1016/j.jtcvs.2015.11.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 11/25/2015] [Indexed: 11/29/2022]
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230
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Pazdernik M, Kautzner J, Sochman J, Kettner J, Vojacek J, Pelouch R. Clinical manifestations of infective endocarditis in relation to infectious agents: An 8-year retrospective study. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2016; 160:298-304. [PMID: 26740050 DOI: 10.5507/bp.2015.062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 12/01/2015] [Indexed: 11/23/2022] Open
Abstract
AIM To compare clinical complications and outcomes of infective endocarditis (IE) episodes caused by Staphylococcus aureus (S. aureus) and other most frequent aetiological agents (streptococci, enterococci, coagulase-negative staphylococci, and culture-negative IE). METHODS A total of 117 IE episodes assessed by all internal medicine services of a major teaching institution in the Czech Republic over an eight-year period were identified. RESULTS We found that S. aureus IE episodes (n = 36) were significantly more associated with systemic embolism (41.7% vs 18.5%, P = 0.01), severe sepsis/septic shock (33.3% vs 3.7%, P < 0.0001), and in-hospital mortality (33% vs 12.3%, P = 0.01). No differences in local, structural, and/or functional complications (cardiac abscess formation, impaired integrity of the valvular apparatus, conduction disturbances, or incidence of heart failure) were observed between studied groups. Long-term survival estimates were significantly improved in patients with IE caused by agents other than S. aureus (13.78 median years vs 5.48 median years, P=0.03). CONCLUSIONS IE episodes caused by S. aureus are associated with both increased short-term and long-term mortality. Of all the studied parameters, only systemic embolism and severe sepsis/septic shock predicted in-hospital mortality.
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Affiliation(s)
- Michal Pazdernik
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Jan Sochman
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Jiri Kettner
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Jan Vojacek
- 1st Department of Internal Medicine - Cardioangiology, Faculty Hospital in Hradec Kralove, Czech Republic
| | - Radek Pelouch
- 1st Department of Internal Medicine - Cardioangiology, Faculty Hospital in Hradec Kralove, Czech Republic
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231
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Koray A, Akalın F, Şaylan Çevik B, İsbir S, Arsan S. Disseminated Peripheral Mycotic Aneurysms and Septic Embolizations Related to an Infected Stent Deployed for Restenosis of Surgically Repaired Supravalvular Aortic Stenosis. World J Pediatr Congenit Heart Surg 2015; 7:104-7. [PMID: 26715003 DOI: 10.1177/2150135115578179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Percutaneous treatment of supravalvular aortic stenosis (SVAS) by means of balloon dilation and stent deployment has been rarely reported in the literature. In this report, we present the case of a patient with mycotic aneurysms, disseminated peripheral and cerebral septic embolizations, and infected vegetations associated with a stent that had previously been deployed to treat restenosis of surgically corrected SVAS in the infancy.
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Affiliation(s)
- Ak Koray
- Department of Cardiovascular Surgery, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Figen Akalın
- Department of Pediatric Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Berna Şaylan Çevik
- Department of Pediatric Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Selim İsbir
- Department of Cardiovascular Surgery, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Sinan Arsan
- Department of Cardiovascular Surgery, Marmara University Faculty of Medicine, Istanbul, Turkey
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232
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Iung B, Doco-Lecompte T, Chocron S, Strady C, Delahaye F, Le Moing V, Poyart C, Alla F, Cambau E, Tattevin P, Chirouze C, Obadia JF, Duval X, Hoen B. Cardiac surgery during the acute phase of infective endocarditis: discrepancies between European Society of Cardiology guidelines and practices. Eur Heart J 2015; 37:840-8. [PMID: 26685134 DOI: 10.1093/eurheartj/ehv650] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 11/12/2015] [Indexed: 12/20/2022] Open
Abstract
AIMS Indications for surgery in acute infective endocarditis (IE) are detailed in guidelines, but their application is not well known. We analysed the agreement between the patient's attending physicians and European Society of Cardiology guidelines regarding indications for surgery. We also assessed whether surgery was performed in patients who had an indication. METHODS AND RESULTS From the 2008 prospective population-based French survey on IE, 303 patients with definite left-sided native IE were identified. For each case, we prospectively recorded (i) indication for surgery according to the attending physicians and (ii) indication for surgery according to guidelines. Surgery was indicated in 194 (65%) patients according to attending physicians and in 221 (73%) according to guidelines, while 139 (46%) underwent surgery. Agreement was moderate between attending physicians and guidelines (kappa 0.41-0.59) and between indication according to guidelines and the performance of surgery (kappa 0.38). Of the 90 (30%) patients not operated despite indication, contraindication to surgery was reported by the attending physicians in 42 (47%), and indication was not identified in 48 (53%). One-year survival was 76% in patients with indication and surgery performed (n = 131), 69% in patients without indication and no surgery (n = 74), 56% in patients with identified indication and contraindication to surgery (n = 42), and 60% in patients with no identified indication (n = 48; P = 0.059). CONCLUSION Cardiac surgery during acute IE was recommended in almost three out of four patients, although fewer than half were actually operated. Indication was not acknowledged by the attending physicians in one out of six patients.
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Affiliation(s)
- Bernard Iung
- Département de Cardiologie, AP-HP, Hôpital Bichat, Université Paris-Diderot, DHU Fire, 46 rue Henri Huchard, 75018 Paris, France
| | - Thanh Doco-Lecompte
- Maladies Infectieuses et Tropicales, Hôpitaux Universitaires de Genève, Geneve, Switzerland
| | - Sidney Chocron
- Service de Chirurgie Cardiaque, Centre Hospitalier Universitaire, Besançon, France
| | - Christophe Strady
- Cabinet d'Infectiologie. Clinique Saint André-Groupe Courlancy, Reims, France
| | - François Delahaye
- Hôpital Louis Pradel, Hospices Civils de Lyon, Université Claude Bernard, Lyon, France
| | - Vincent Le Moing
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Régional Universitaire de Montpellier, Montpellier, France Unité Mixte de Recherche 145 Institut de Recherche sur le Développement/Université Montpellier 1, Montpellier, France
| | - Claire Poyart
- AP-HP, Service de Bactériologie, Centre National de Référence des Streptocoques (CNR-Strep), Hôpital Cochin, Paris, France Institut Cochin, Université Paris Descartes, Faculté de médecine, CNRS (UMR 8104), Paris, France Inserm, U1016, Paris, France
| | - François Alla
- EA 4003, Université de Nancy, Nancy, France Inserm CIC 007, Nancy, France
| | - Emmanuelle Cambau
- AP-HP, Hôpital Lariboisière, Service de Bactériologie, Paris, France Université Paris Diderot, Sorbonne Paris Cité, IAME UMR1137, Paris, France
| | - Pierre Tattevin
- Unité de Soins Intensifs et de Maladies Infectieuses, Hôpital Universitaire Pontchaillou, Rennes, France
| | - Catherine Chirouze
- Maladies Infectieuses et Tropicales. Centre Hospitalier Universitaire, Besançon, France
| | - Jean-François Obadia
- Hôpital Louis Pradel, Lyon, Chirurgie Cardiothoracique et Transplantation, Bron, France
| | - Xavier Duval
- AP-HP, Centre d'Investigation Clinique Inserm 1425, Hôpital Bichat, Université Paris-Diderot, Inserm U1137, Paris, France
| | - Bruno Hoen
- Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud, EA 4537, Pointe-à-Pitre, France Centre Hospitalier Universitaire de Pointe-à-Pitre, Inserm CIC1424, Service de Maladies Infectieuses et Tropicales, Dermatologie, Médecine Interne, Pointe-à-Pitre, France
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233
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Buitron de la Vega P, Tandon P, Qureshi W, Nasr Y, Jayaprakash R, Arshad S, Moreno D, Jacobsen G, Ananthasubramaniam K, Ramesh M, Zervos M. Simplified risk stratification criteria for identification of patients with MRSA bacteremia at low risk of infective endocarditis: implications for avoiding routine transesophageal echocardiography in MRSA bacteremia. Eur J Clin Microbiol Infect Dis 2015; 35:261-8. [PMID: 26676855 PMCID: PMC4724372 DOI: 10.1007/s10096-015-2539-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 11/24/2015] [Indexed: 12/11/2022]
Abstract
The aim of this study was to identify patients with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia with low risk of infective endocarditis (IE) who might not require routine trans-esophageal echocardiography (TEE). We retrospectively evaluated 398 patients presenting with MRSA bacteremia for the presence of the following clinical criteria: intravenous drug abuse (IVDA), long-term catheter, prolonged bacteremia, intra-cardiac device, prosthetic valve, hemodialysis dependency, vertebral/nonvertebral osteomyelitis, cardio-structural abnormality. IE was diagnosed using the modified Duke criteria. Of 398 patients with MRSA bacteremia, 26.4 % of cases were community-acquired, 56.3 % were health-care-associated, and 17.3 % were hospital-acquired. Of the group, 44 patients had definite IE, 119 had possible IE, and 235 had a rejected diagnosis. Out of 398 patients, 231 were evaluated with transthoracic echocardiography (TTE) or TEE. All 44 patients with definite IE fulfilled at least one criterion (sensitivity 100 %). Finally, a receiver operator characteristic (ROC) curve was obtained to evaluate the total risk score of our proposed criteria as a predictor of the presence of IE, and this was compared to the ROC curve of a previously proposed criteria. The area under the ROC curve for our criteria was 0.710, while the area under the ROC curve for the criteria previously proposed was 0.537 (p < 0.001). The p-value for comparing those 2 areas was less than 0.001, indicating statistical significance. Patients with MRSA bacteremia without any of our proposed clinical criteria have very low risk of developing IE and may not require routine TEE.
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Affiliation(s)
- P Buitron de la Vega
- Division of Internal Medicine, Boston Medical Center, 801 Massachusetts Ave Crosstown, 2nd Floor, Boston, MA, 02118, USA. .,Boston University, Boston, MA, USA.
| | - P Tandon
- Division of Internal Medicine, Ottawa Hospital, Ottawa, ON, Canada
| | - W Qureshi
- Division of Cardiology, Department of Internal Medicine, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Y Nasr
- Heart and Vascular Institute, Henry Ford Health System, Detroit, MI, USA
| | - R Jayaprakash
- Government Kilpauk Medical College Hospital, Chennai, India
| | - S Arshad
- Division of Infectious Diseases, Henry Ford Health System, Detroit, MI, USA
| | - D Moreno
- Division of Infectious Diseases, Henry Ford Health System, Detroit, MI, USA
| | - G Jacobsen
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | - K Ananthasubramaniam
- Wayne State University School of Medicine, Detroit, MI, USA.,Heart and Vascular Institute, Henry Ford Health System, Detroit, MI, USA
| | - M Ramesh
- Division of Infectious Diseases, Henry Ford Health System, Detroit, MI, USA.,Wayne State University School of Medicine, Detroit, MI, USA
| | - M Zervos
- Division of Infectious Diseases, Henry Ford Health System, Detroit, MI, USA.,Wayne State University School of Medicine, Detroit, MI, USA
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234
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A Spiral in the Heart: Mitral Valve Endocarditis with Unusual Vegetation Shape Potentially Affecting Effectiveness of Antibiotic Therapy. Case Rep Cardiol 2015; 2015:483067. [PMID: 26583074 PMCID: PMC4637073 DOI: 10.1155/2015/483067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 10/15/2015] [Indexed: 11/17/2022] Open
Abstract
We report an unusual case of infective endocarditis (IE) in an 88-year-old woman, occurring on a prolapsing mitral valve and characterized by an atypical vegetation shape resembling a spiral-like appearance. After the patient refused surgical correction, persistent IE despite prolonged antibiotic therapy was observed, resulting in an ischemic stroke probably secondary to septic embolus. The importance of vegetation shape in the management of patients with IE was classically related to the increased risk of embolization associated with pedunculated, irregular, and multilobed masses. We hypothesize that the unusual spiral-like vegetation shape in our patient may have favored IE persistence by two mechanisms, namely, a decrease of the exposed vegetation surface with creation of an internal core where the penetration of antimicrobial agents was obstacled and the creation of blood turbulence within the vegetation preventing a prolonged contact with circulating antibiotics. These considerations suggest that vegetation shape might be considered of importance in patients with IE not only because of its classical association with embolization risk, but also because of its potential effect on the efficacy of antibiotic therapy.
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235
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Morita K, Sasabuchi Y, Matsui H, Fushimi K, Yasunaga H. Outcomes after early or late timing of surgery for infective endocarditis with ischaemic stroke: a retrospective cohort study. Interact Cardiovasc Thorac Surg 2015; 21:604-609. [DOI: 10.1093/icvts/ivv235] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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236
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Honarbakhsh S, Chowdhury M, Farooqi F, Deaner A. Syncope secondary to left ventricular outflow tract obstruction, an interesting presentation of infective endocarditis. BMJ Case Rep 2015; 2015:bcr-2015-211920. [PMID: 26392460 DOI: 10.1136/bcr-2015-211920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We describe a case of a 74-year-old woman who presented with symptoms of fever and lethargy, associated with an episode of cardiac syncope and exertional shortness of breath (SOB). She was diagnosed with Staphylococcus aureus infective mural endocarditis (IE) and subsequent transoesophageal echocardiogram (TOE) confirmed this diagnosis. As the vegetative mass arose from the septal wall, an unusual location, it caused left ventricular outflow tract (LVOT) obstruction and therefore behaved similarly to a subaortic valvular stenosis. There were no conduction abnormalities on the ECG and no clinical or echocardiographic features of congestive heart failure. The finding of LVOT obstruction explained the unusual presentation with syncope and exertional SOB making this case unique. Owing to the large vegetative mass and thereby its high risk of septic emboli, the patient underwent successful surgical resection of the mass with resolution of the obstruction. She successfully completed intravenous antibiotics and was discharged from hospital.
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Affiliation(s)
- Shohreh Honarbakhsh
- Department of Cardiology, King George Hospital; Barking, Havering and Redbridge NHS Trust, London, UK
| | - Mohammad Chowdhury
- Department of Cardiology, King George Hospital; Barking, Havering and Redbridge NHS Trust, London, UK
| | - Fahad Farooqi
- Department of Cardiology, King George Hospital; Barking, Havering and Redbridge NHS Trust, London, UK
| | - Andrew Deaner
- Department of Cardiology, King George Hospital; Barking, Havering and Redbridge NHS Trust, London, UK
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237
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Baddour LM, Wilson WR, Bayer AS, Fowler VG, Tleyjeh IM, Rybak MJ, Barsic B, Lockhart PB, Gewitz MH, Levison ME, Bolger AF, Steckelberg JM, Baltimore RS, Fink AM, O'Gara P, Taubert KA. Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association. Circulation 2015; 132:1435-86. [PMID: 26373316 DOI: 10.1161/cir.0000000000000296] [Citation(s) in RCA: 1889] [Impact Index Per Article: 209.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Infective endocarditis is a potentially lethal disease that has undergone major changes in both host and pathogen. The epidemiology of infective endocarditis has become more complex with today's myriad healthcare-associated factors that predispose to infection. Moreover, changes in pathogen prevalence, in particular a more common staphylococcal origin, have affected outcomes, which have not improved despite medical and surgical advances. METHODS AND RESULTS This statement updates the 2005 iteration, both of which were developed by the American Heart Association under the auspices of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease of the Young. It includes an evidence-based system for diagnostic and treatment recommendations used by the American College of Cardiology and the American Heart Association for treatment recommendations. CONCLUSIONS Infective endocarditis is a complex disease, and patients with this disease generally require management by a team of physicians and allied health providers with a variety of areas of expertise. The recommendations provided in this document are intended to assist in the management of this uncommon but potentially deadly infection. The clinical variability and complexity in infective endocarditis, however, dictate that these recommendations be used to support and not supplant decisions in individual patient management.
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238
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Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, Dulgheru R, El Khoury G, Erba PA, Iung B, Miro JM, Mulder BJ, Plonska-Gosciniak E, Price S, Roos-Hesselink J, Snygg-Martin U, Thuny F, Tornos Mas P, Vilacosta I, Zamorano JL. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 2015; 36:3075-3128. [PMID: 26320109 DOI: 10.1093/eurheartj/ehv319] [Citation(s) in RCA: 3158] [Impact Index Per Article: 350.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
MESH Headings
- Acute Kidney Injury/diagnosis
- Acute Kidney Injury/therapy
- Ambulatory Care
- Aneurysm, Infected/diagnosis
- Aneurysm, Infected/therapy
- Anti-Bacterial Agents/therapeutic use
- Antibiotic Prophylaxis
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/therapy
- Clinical Laboratory Techniques
- Critical Care
- Cross Infection/etiology
- Dentistry, Operative
- Diagnostic Imaging/methods
- Embolism/diagnosis
- Embolism/therapy
- Endocarditis/diagnosis
- Endocarditis/therapy
- Endocarditis, Non-Infective/diagnosis
- Endocarditis, Non-Infective/therapy
- Female
- Fibrinolytic Agents/therapeutic use
- Heart Defects, Congenital
- Heart Failure/diagnosis
- Heart Failure/therapy
- Heart Valve Diseases/diagnosis
- Heart Valve Diseases/therapy
- Humans
- Long-Term Care
- Microbiological Techniques
- Musculoskeletal Diseases/diagnosis
- Musculoskeletal Diseases/microbiology
- Musculoskeletal Diseases/therapy
- Myocarditis/diagnosis
- Myocarditis/therapy
- Neoplasms/complications
- Nervous System Diseases/diagnosis
- Nervous System Diseases/microbiology
- Nervous System Diseases/therapy
- Patient Care Team
- Pericarditis/diagnosis
- Pericarditis/therapy
- Postoperative Complications/etiology
- Postoperative Complications/prevention & control
- Pregnancy
- Pregnancy Complications, Cardiovascular/diagnosis
- Pregnancy Complications, Cardiovascular/therapy
- Prognosis
- Prosthesis-Related Infections/diagnosis
- Prosthesis-Related Infections/therapy
- Recurrence
- Risk Assessment
- Risk Factors
- Splenic Diseases/diagnosis
- Splenic Diseases/therapy
- Thoracic Surgical Procedures
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239
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Abstract
In this review, cardiac arrest is discussed, with a focus on neuroprognostication and the emerging data, with regard to identifying more accurate predictors of neurologic outcomes in the era of therapeutic hypothermia. Topics discussed include recent controversies with regard to targeted temperature management in comatose survivors of cardiac arrest; neurologic complications associated with surgical disease and procedures, namely aortic dissection, infective endocarditis, left ventricular assist devices, and coronary artery bypass grafting; and the cause, pathogenesis, and management of neurogenic stunned myocardium.
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240
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Lauridsen TK, Park L, Tong SYC, Selton-Suty C, Peterson G, Cecchi E, Afonso L, Habib G, Paré C, Tamin S, Dickerman S, Bayer AS, Johansson MC, Chu VH, Samad Z, Bruun NE, Fowler VG, Crowley AL. Echocardiographic Findings Predict In-Hospital and 1-Year Mortality in Left-Sided Native Valve Staphylococcus aureus Endocarditis: Analysis From the International Collaboration on Endocarditis-Prospective Echo Cohort Study. Circ Cardiovasc Imaging 2015; 8:e003397. [PMID: 26162783 DOI: 10.1161/circimaging.114.003397] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Staphylococcus aureus left-sided native valve infective endocarditis (LNVIE) has higher complication and mortality rates compared with endocarditis from other pathogens. Whether echocardiographic variables can predict prognosis in S aureus LNVIE is unknown. METHODS AND RESULTS Consecutive patients with LNVIE, enrolled between January 2000 and September 2006, in the International Collaboration on Endocarditis were identified. Subjects without S aureus IE were matched to those with S aureus IE by the propensity of having S aureus. Survival differences were determined using log-rank significance tests. Independent echocardiographic predictors of mortality were identified using Cox-proportional hazards models that included inverse probability of treatment weighting and surgery as a time-dependent covariate. Of 727 subjects with LNVIE and 1-year follow-up, 202 had S aureus IE. One-year survival rates were significantly lower for patients with S aureus IE overall (57% S aureus IE versus 80% non-S aureus IE; P<0.001) and in the propensity-matched cohort (59% S aureus IE versus 68% non-S aureus IE; P<0.05). Intracardiac abscess (hazard ratio, 2.93; 95% confidence interval, 1.52-5.40; P<0.001) and left ventricular ejection fraction <40% (odds ratio, 3.01; 95% confidence interval, 1.35-6.04; P=0.004) were the only independent echocardiographic predictors of in-hospital mortality in S aureus LNVIE. Valve perforation (hazard ratio, 2.16; 95% confidence interval, 1.21-3.68; P=0.006) and intracardiac abscess (hazard ratio, 2.25; 95% confidence interval, 1.26-3.78; P=0.004) were the only independent predictors of 1-year mortality. CONCLUSIONS S aureus is an independent predictor of 1-year mortality in subjects with LNVIE. In S aureus LNVIE, intracardiac abscess and left ventricular ejection fraction <40% independently predicted in-hospital mortality and intracardiac abscess and valve perforation independently predicted 1-year mortality.
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Affiliation(s)
- Trine K Lauridsen
- From the Department of Medicine, Duke University, Durham, NC (T.K.L., L.P., V.H.C., Z.S., V.G.F., A.L.C.); Department of Cardiology, Gentofte University, Copenhagen, Denmark (T.K.L., N.E.B.); Department of Infectious Diseases, Charles Darwin University, Darwin, Northern Territory, Australia (S.Y.C.T.); Department of Cardiology, CHU Nancy-Brabois, Nancy, France (C.S.-S.); Department of Medicine, UT-Southwestern Medical Center, Dallas, TX (G.P.); Department of Cardiology, Maria Vittoria Hospital, Torino, Italy (E.C.); Department of Medicine, Wayne State University, Detroit, MI (L.A.); Faculté de Médecine de Marseille, Marseille, France (G.H.); Department of Cardiology, University of Barcelona, Spain (C.P.); Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia (S.T.); Department of Medicine, New York University (S.D.); Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance, University of California, Los Angeles (A.S.B.); Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (M.C.J.); Duke Clinical Research Institute, Durham, NC (V.H.C., V.G.F., A.L.C.); and Clinical Institute, Aalborg University, Aalborg, Denmark (N.E.B.)
| | - Lawrence Park
- From the Department of Medicine, Duke University, Durham, NC (T.K.L., L.P., V.H.C., Z.S., V.G.F., A.L.C.); Department of Cardiology, Gentofte University, Copenhagen, Denmark (T.K.L., N.E.B.); Department of Infectious Diseases, Charles Darwin University, Darwin, Northern Territory, Australia (S.Y.C.T.); Department of Cardiology, CHU Nancy-Brabois, Nancy, France (C.S.-S.); Department of Medicine, UT-Southwestern Medical Center, Dallas, TX (G.P.); Department of Cardiology, Maria Vittoria Hospital, Torino, Italy (E.C.); Department of Medicine, Wayne State University, Detroit, MI (L.A.); Faculté de Médecine de Marseille, Marseille, France (G.H.); Department of Cardiology, University of Barcelona, Spain (C.P.); Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia (S.T.); Department of Medicine, New York University (S.D.); Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance, University of California, Los Angeles (A.S.B.); Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (M.C.J.); Duke Clinical Research Institute, Durham, NC (V.H.C., V.G.F., A.L.C.); and Clinical Institute, Aalborg University, Aalborg, Denmark (N.E.B.)
| | - Steven Y C Tong
- From the Department of Medicine, Duke University, Durham, NC (T.K.L., L.P., V.H.C., Z.S., V.G.F., A.L.C.); Department of Cardiology, Gentofte University, Copenhagen, Denmark (T.K.L., N.E.B.); Department of Infectious Diseases, Charles Darwin University, Darwin, Northern Territory, Australia (S.Y.C.T.); Department of Cardiology, CHU Nancy-Brabois, Nancy, France (C.S.-S.); Department of Medicine, UT-Southwestern Medical Center, Dallas, TX (G.P.); Department of Cardiology, Maria Vittoria Hospital, Torino, Italy (E.C.); Department of Medicine, Wayne State University, Detroit, MI (L.A.); Faculté de Médecine de Marseille, Marseille, France (G.H.); Department of Cardiology, University of Barcelona, Spain (C.P.); Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia (S.T.); Department of Medicine, New York University (S.D.); Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance, University of California, Los Angeles (A.S.B.); Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (M.C.J.); Duke Clinical Research Institute, Durham, NC (V.H.C., V.G.F., A.L.C.); and Clinical Institute, Aalborg University, Aalborg, Denmark (N.E.B.)
| | - Christine Selton-Suty
- From the Department of Medicine, Duke University, Durham, NC (T.K.L., L.P., V.H.C., Z.S., V.G.F., A.L.C.); Department of Cardiology, Gentofte University, Copenhagen, Denmark (T.K.L., N.E.B.); Department of Infectious Diseases, Charles Darwin University, Darwin, Northern Territory, Australia (S.Y.C.T.); Department of Cardiology, CHU Nancy-Brabois, Nancy, France (C.S.-S.); Department of Medicine, UT-Southwestern Medical Center, Dallas, TX (G.P.); Department of Cardiology, Maria Vittoria Hospital, Torino, Italy (E.C.); Department of Medicine, Wayne State University, Detroit, MI (L.A.); Faculté de Médecine de Marseille, Marseille, France (G.H.); Department of Cardiology, University of Barcelona, Spain (C.P.); Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia (S.T.); Department of Medicine, New York University (S.D.); Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance, University of California, Los Angeles (A.S.B.); Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (M.C.J.); Duke Clinical Research Institute, Durham, NC (V.H.C., V.G.F., A.L.C.); and Clinical Institute, Aalborg University, Aalborg, Denmark (N.E.B.)
| | - Gail Peterson
- From the Department of Medicine, Duke University, Durham, NC (T.K.L., L.P., V.H.C., Z.S., V.G.F., A.L.C.); Department of Cardiology, Gentofte University, Copenhagen, Denmark (T.K.L., N.E.B.); Department of Infectious Diseases, Charles Darwin University, Darwin, Northern Territory, Australia (S.Y.C.T.); Department of Cardiology, CHU Nancy-Brabois, Nancy, France (C.S.-S.); Department of Medicine, UT-Southwestern Medical Center, Dallas, TX (G.P.); Department of Cardiology, Maria Vittoria Hospital, Torino, Italy (E.C.); Department of Medicine, Wayne State University, Detroit, MI (L.A.); Faculté de Médecine de Marseille, Marseille, France (G.H.); Department of Cardiology, University of Barcelona, Spain (C.P.); Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia (S.T.); Department of Medicine, New York University (S.D.); Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance, University of California, Los Angeles (A.S.B.); Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (M.C.J.); Duke Clinical Research Institute, Durham, NC (V.H.C., V.G.F., A.L.C.); and Clinical Institute, Aalborg University, Aalborg, Denmark (N.E.B.)
| | - Enrico Cecchi
- From the Department of Medicine, Duke University, Durham, NC (T.K.L., L.P., V.H.C., Z.S., V.G.F., A.L.C.); Department of Cardiology, Gentofte University, Copenhagen, Denmark (T.K.L., N.E.B.); Department of Infectious Diseases, Charles Darwin University, Darwin, Northern Territory, Australia (S.Y.C.T.); Department of Cardiology, CHU Nancy-Brabois, Nancy, France (C.S.-S.); Department of Medicine, UT-Southwestern Medical Center, Dallas, TX (G.P.); Department of Cardiology, Maria Vittoria Hospital, Torino, Italy (E.C.); Department of Medicine, Wayne State University, Detroit, MI (L.A.); Faculté de Médecine de Marseille, Marseille, France (G.H.); Department of Cardiology, University of Barcelona, Spain (C.P.); Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia (S.T.); Department of Medicine, New York University (S.D.); Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance, University of California, Los Angeles (A.S.B.); Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (M.C.J.); Duke Clinical Research Institute, Durham, NC (V.H.C., V.G.F., A.L.C.); and Clinical Institute, Aalborg University, Aalborg, Denmark (N.E.B.)
| | - Luis Afonso
- From the Department of Medicine, Duke University, Durham, NC (T.K.L., L.P., V.H.C., Z.S., V.G.F., A.L.C.); Department of Cardiology, Gentofte University, Copenhagen, Denmark (T.K.L., N.E.B.); Department of Infectious Diseases, Charles Darwin University, Darwin, Northern Territory, Australia (S.Y.C.T.); Department of Cardiology, CHU Nancy-Brabois, Nancy, France (C.S.-S.); Department of Medicine, UT-Southwestern Medical Center, Dallas, TX (G.P.); Department of Cardiology, Maria Vittoria Hospital, Torino, Italy (E.C.); Department of Medicine, Wayne State University, Detroit, MI (L.A.); Faculté de Médecine de Marseille, Marseille, France (G.H.); Department of Cardiology, University of Barcelona, Spain (C.P.); Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia (S.T.); Department of Medicine, New York University (S.D.); Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance, University of California, Los Angeles (A.S.B.); Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (M.C.J.); Duke Clinical Research Institute, Durham, NC (V.H.C., V.G.F., A.L.C.); and Clinical Institute, Aalborg University, Aalborg, Denmark (N.E.B.)
| | - Gilbert Habib
- From the Department of Medicine, Duke University, Durham, NC (T.K.L., L.P., V.H.C., Z.S., V.G.F., A.L.C.); Department of Cardiology, Gentofte University, Copenhagen, Denmark (T.K.L., N.E.B.); Department of Infectious Diseases, Charles Darwin University, Darwin, Northern Territory, Australia (S.Y.C.T.); Department of Cardiology, CHU Nancy-Brabois, Nancy, France (C.S.-S.); Department of Medicine, UT-Southwestern Medical Center, Dallas, TX (G.P.); Department of Cardiology, Maria Vittoria Hospital, Torino, Italy (E.C.); Department of Medicine, Wayne State University, Detroit, MI (L.A.); Faculté de Médecine de Marseille, Marseille, France (G.H.); Department of Cardiology, University of Barcelona, Spain (C.P.); Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia (S.T.); Department of Medicine, New York University (S.D.); Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance, University of California, Los Angeles (A.S.B.); Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (M.C.J.); Duke Clinical Research Institute, Durham, NC (V.H.C., V.G.F., A.L.C.); and Clinical Institute, Aalborg University, Aalborg, Denmark (N.E.B.)
| | - Carlos Paré
- From the Department of Medicine, Duke University, Durham, NC (T.K.L., L.P., V.H.C., Z.S., V.G.F., A.L.C.); Department of Cardiology, Gentofte University, Copenhagen, Denmark (T.K.L., N.E.B.); Department of Infectious Diseases, Charles Darwin University, Darwin, Northern Territory, Australia (S.Y.C.T.); Department of Cardiology, CHU Nancy-Brabois, Nancy, France (C.S.-S.); Department of Medicine, UT-Southwestern Medical Center, Dallas, TX (G.P.); Department of Cardiology, Maria Vittoria Hospital, Torino, Italy (E.C.); Department of Medicine, Wayne State University, Detroit, MI (L.A.); Faculté de Médecine de Marseille, Marseille, France (G.H.); Department of Cardiology, University of Barcelona, Spain (C.P.); Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia (S.T.); Department of Medicine, New York University (S.D.); Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance, University of California, Los Angeles (A.S.B.); Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (M.C.J.); Duke Clinical Research Institute, Durham, NC (V.H.C., V.G.F., A.L.C.); and Clinical Institute, Aalborg University, Aalborg, Denmark (N.E.B.)
| | - Syahidah Tamin
- From the Department of Medicine, Duke University, Durham, NC (T.K.L., L.P., V.H.C., Z.S., V.G.F., A.L.C.); Department of Cardiology, Gentofte University, Copenhagen, Denmark (T.K.L., N.E.B.); Department of Infectious Diseases, Charles Darwin University, Darwin, Northern Territory, Australia (S.Y.C.T.); Department of Cardiology, CHU Nancy-Brabois, Nancy, France (C.S.-S.); Department of Medicine, UT-Southwestern Medical Center, Dallas, TX (G.P.); Department of Cardiology, Maria Vittoria Hospital, Torino, Italy (E.C.); Department of Medicine, Wayne State University, Detroit, MI (L.A.); Faculté de Médecine de Marseille, Marseille, France (G.H.); Department of Cardiology, University of Barcelona, Spain (C.P.); Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia (S.T.); Department of Medicine, New York University (S.D.); Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance, University of California, Los Angeles (A.S.B.); Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (M.C.J.); Duke Clinical Research Institute, Durham, NC (V.H.C., V.G.F., A.L.C.); and Clinical Institute, Aalborg University, Aalborg, Denmark (N.E.B.)
| | - Stuart Dickerman
- From the Department of Medicine, Duke University, Durham, NC (T.K.L., L.P., V.H.C., Z.S., V.G.F., A.L.C.); Department of Cardiology, Gentofte University, Copenhagen, Denmark (T.K.L., N.E.B.); Department of Infectious Diseases, Charles Darwin University, Darwin, Northern Territory, Australia (S.Y.C.T.); Department of Cardiology, CHU Nancy-Brabois, Nancy, France (C.S.-S.); Department of Medicine, UT-Southwestern Medical Center, Dallas, TX (G.P.); Department of Cardiology, Maria Vittoria Hospital, Torino, Italy (E.C.); Department of Medicine, Wayne State University, Detroit, MI (L.A.); Faculté de Médecine de Marseille, Marseille, France (G.H.); Department of Cardiology, University of Barcelona, Spain (C.P.); Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia (S.T.); Department of Medicine, New York University (S.D.); Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance, University of California, Los Angeles (A.S.B.); Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (M.C.J.); Duke Clinical Research Institute, Durham, NC (V.H.C., V.G.F., A.L.C.); and Clinical Institute, Aalborg University, Aalborg, Denmark (N.E.B.)
| | - Arnold S Bayer
- From the Department of Medicine, Duke University, Durham, NC (T.K.L., L.P., V.H.C., Z.S., V.G.F., A.L.C.); Department of Cardiology, Gentofte University, Copenhagen, Denmark (T.K.L., N.E.B.); Department of Infectious Diseases, Charles Darwin University, Darwin, Northern Territory, Australia (S.Y.C.T.); Department of Cardiology, CHU Nancy-Brabois, Nancy, France (C.S.-S.); Department of Medicine, UT-Southwestern Medical Center, Dallas, TX (G.P.); Department of Cardiology, Maria Vittoria Hospital, Torino, Italy (E.C.); Department of Medicine, Wayne State University, Detroit, MI (L.A.); Faculté de Médecine de Marseille, Marseille, France (G.H.); Department of Cardiology, University of Barcelona, Spain (C.P.); Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia (S.T.); Department of Medicine, New York University (S.D.); Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance, University of California, Los Angeles (A.S.B.); Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (M.C.J.); Duke Clinical Research Institute, Durham, NC (V.H.C., V.G.F., A.L.C.); and Clinical Institute, Aalborg University, Aalborg, Denmark (N.E.B.)
| | - Magnus C Johansson
- From the Department of Medicine, Duke University, Durham, NC (T.K.L., L.P., V.H.C., Z.S., V.G.F., A.L.C.); Department of Cardiology, Gentofte University, Copenhagen, Denmark (T.K.L., N.E.B.); Department of Infectious Diseases, Charles Darwin University, Darwin, Northern Territory, Australia (S.Y.C.T.); Department of Cardiology, CHU Nancy-Brabois, Nancy, France (C.S.-S.); Department of Medicine, UT-Southwestern Medical Center, Dallas, TX (G.P.); Department of Cardiology, Maria Vittoria Hospital, Torino, Italy (E.C.); Department of Medicine, Wayne State University, Detroit, MI (L.A.); Faculté de Médecine de Marseille, Marseille, France (G.H.); Department of Cardiology, University of Barcelona, Spain (C.P.); Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia (S.T.); Department of Medicine, New York University (S.D.); Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance, University of California, Los Angeles (A.S.B.); Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (M.C.J.); Duke Clinical Research Institute, Durham, NC (V.H.C., V.G.F., A.L.C.); and Clinical Institute, Aalborg University, Aalborg, Denmark (N.E.B.)
| | - Vivian H Chu
- From the Department of Medicine, Duke University, Durham, NC (T.K.L., L.P., V.H.C., Z.S., V.G.F., A.L.C.); Department of Cardiology, Gentofte University, Copenhagen, Denmark (T.K.L., N.E.B.); Department of Infectious Diseases, Charles Darwin University, Darwin, Northern Territory, Australia (S.Y.C.T.); Department of Cardiology, CHU Nancy-Brabois, Nancy, France (C.S.-S.); Department of Medicine, UT-Southwestern Medical Center, Dallas, TX (G.P.); Department of Cardiology, Maria Vittoria Hospital, Torino, Italy (E.C.); Department of Medicine, Wayne State University, Detroit, MI (L.A.); Faculté de Médecine de Marseille, Marseille, France (G.H.); Department of Cardiology, University of Barcelona, Spain (C.P.); Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia (S.T.); Department of Medicine, New York University (S.D.); Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance, University of California, Los Angeles (A.S.B.); Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (M.C.J.); Duke Clinical Research Institute, Durham, NC (V.H.C., V.G.F., A.L.C.); and Clinical Institute, Aalborg University, Aalborg, Denmark (N.E.B.)
| | - Zainab Samad
- From the Department of Medicine, Duke University, Durham, NC (T.K.L., L.P., V.H.C., Z.S., V.G.F., A.L.C.); Department of Cardiology, Gentofte University, Copenhagen, Denmark (T.K.L., N.E.B.); Department of Infectious Diseases, Charles Darwin University, Darwin, Northern Territory, Australia (S.Y.C.T.); Department of Cardiology, CHU Nancy-Brabois, Nancy, France (C.S.-S.); Department of Medicine, UT-Southwestern Medical Center, Dallas, TX (G.P.); Department of Cardiology, Maria Vittoria Hospital, Torino, Italy (E.C.); Department of Medicine, Wayne State University, Detroit, MI (L.A.); Faculté de Médecine de Marseille, Marseille, France (G.H.); Department of Cardiology, University of Barcelona, Spain (C.P.); Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia (S.T.); Department of Medicine, New York University (S.D.); Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance, University of California, Los Angeles (A.S.B.); Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (M.C.J.); Duke Clinical Research Institute, Durham, NC (V.H.C., V.G.F., A.L.C.); and Clinical Institute, Aalborg University, Aalborg, Denmark (N.E.B.)
| | - Niels E Bruun
- From the Department of Medicine, Duke University, Durham, NC (T.K.L., L.P., V.H.C., Z.S., V.G.F., A.L.C.); Department of Cardiology, Gentofte University, Copenhagen, Denmark (T.K.L., N.E.B.); Department of Infectious Diseases, Charles Darwin University, Darwin, Northern Territory, Australia (S.Y.C.T.); Department of Cardiology, CHU Nancy-Brabois, Nancy, France (C.S.-S.); Department of Medicine, UT-Southwestern Medical Center, Dallas, TX (G.P.); Department of Cardiology, Maria Vittoria Hospital, Torino, Italy (E.C.); Department of Medicine, Wayne State University, Detroit, MI (L.A.); Faculté de Médecine de Marseille, Marseille, France (G.H.); Department of Cardiology, University of Barcelona, Spain (C.P.); Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia (S.T.); Department of Medicine, New York University (S.D.); Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance, University of California, Los Angeles (A.S.B.); Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (M.C.J.); Duke Clinical Research Institute, Durham, NC (V.H.C., V.G.F., A.L.C.); and Clinical Institute, Aalborg University, Aalborg, Denmark (N.E.B.)
| | - Vance G Fowler
- From the Department of Medicine, Duke University, Durham, NC (T.K.L., L.P., V.H.C., Z.S., V.G.F., A.L.C.); Department of Cardiology, Gentofte University, Copenhagen, Denmark (T.K.L., N.E.B.); Department of Infectious Diseases, Charles Darwin University, Darwin, Northern Territory, Australia (S.Y.C.T.); Department of Cardiology, CHU Nancy-Brabois, Nancy, France (C.S.-S.); Department of Medicine, UT-Southwestern Medical Center, Dallas, TX (G.P.); Department of Cardiology, Maria Vittoria Hospital, Torino, Italy (E.C.); Department of Medicine, Wayne State University, Detroit, MI (L.A.); Faculté de Médecine de Marseille, Marseille, France (G.H.); Department of Cardiology, University of Barcelona, Spain (C.P.); Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia (S.T.); Department of Medicine, New York University (S.D.); Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance, University of California, Los Angeles (A.S.B.); Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (M.C.J.); Duke Clinical Research Institute, Durham, NC (V.H.C., V.G.F., A.L.C.); and Clinical Institute, Aalborg University, Aalborg, Denmark (N.E.B.)
| | - Anna Lisa Crowley
- From the Department of Medicine, Duke University, Durham, NC (T.K.L., L.P., V.H.C., Z.S., V.G.F., A.L.C.); Department of Cardiology, Gentofte University, Copenhagen, Denmark (T.K.L., N.E.B.); Department of Infectious Diseases, Charles Darwin University, Darwin, Northern Territory, Australia (S.Y.C.T.); Department of Cardiology, CHU Nancy-Brabois, Nancy, France (C.S.-S.); Department of Medicine, UT-Southwestern Medical Center, Dallas, TX (G.P.); Department of Cardiology, Maria Vittoria Hospital, Torino, Italy (E.C.); Department of Medicine, Wayne State University, Detroit, MI (L.A.); Faculté de Médecine de Marseille, Marseille, France (G.H.); Department of Cardiology, University of Barcelona, Spain (C.P.); Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia (S.T.); Department of Medicine, New York University (S.D.); Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance, University of California, Los Angeles (A.S.B.); Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (M.C.J.); Duke Clinical Research Institute, Durham, NC (V.H.C., V.G.F., A.L.C.); and Clinical Institute, Aalborg University, Aalborg, Denmark (N.E.B.).
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Gough A, Clay K, Williams A, Jackson S, Prendergast B. Infective endocarditis in the military patient. J ROY ARMY MED CORPS 2015; 161:283-7. [PMID: 26243804 DOI: 10.1136/jramc-2015-000504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 06/29/2015] [Indexed: 11/03/2022]
Abstract
Infective endocarditis (IE) is a potentially fatal cardiac infection associated with an inhospital mortality rate of up to 22%. Fifty per cent of IE cases develop in patients with no known history of valve disease. It is therefore important to remain vigilant to the possibility of the diagnosis in patients with a febrile illness and unknown source. From a military perspective, our patients are unique due to the breadth of pathogens they are exposed to, and blood-culture-negative IE is a risk. In particular, there should be awareness of Coxiella burnetii as a possible causative pathogen. In this review we incorporate the latest consensus from systematic reviews and publications identified by a literature search through Medline. We describe the diagnosis and management of IE with particular reference to the military population.
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Affiliation(s)
- Andrew Gough
- Neurology department, Defence Medical Rehabilitation Centre (DMRC), Epsom, UK
| | - K Clay
- Department of Academic Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| | - A Williams
- Cardiology Department, Royal Gwent Hospital, Newport, UK
| | - S Jackson
- Directorate of Manning (Army), Marlborough Lines, Andover, UK
| | - B Prendergast
- Department of Cardiology, Guy's and St Thomas' Hospitals, London, UK
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242
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Bin Abdulhak AA, Baddour LM, Erwin PJ, Hoen B, Chu VH, Mensah GA, Tleyjeh IM. Global and regional burden of infective endocarditis, 1990-2010: a systematic review of the literature. Glob Heart 2015; 9:131-43. [PMID: 25432123 DOI: 10.1016/j.gheart.2014.01.002] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Infective endocarditis (IE) is a life-threatening disease associated with serious complications. The GBD 2010 (Global Burden of Disease, Injuries, and Risk Factors) study IE expert group conducted a systematic review of IE epidemiology literature to inform estimates of the burden on IE in 21 world regions in 1990 and 2010. The disease model of IE for the GBD 2010 study included IE death and 2 sequelae: stroke and valve surgery. Several medical and science databases were searched for IE epidemiology studies in GBD high-, low-, and middle-income regions published between 1980 and 2008. The epidemiologic parameters of interest were IE incidence, proportions of IE patients who developed stroke or underwent valve surgery, and case fatality. Literature searches yielded 1,975 unique papers, of which 115 published in 10 languages were included in the systematic review. Eligible studies were population-based (17%), multicenter hospital-based (11%), and single-center hospital-based studies (71%). Population-based studies were reported from only 6 world regions. Data were missing or sparse in many low- and middle-income regions. The crude incidence of IE ranged between 1.5 and 11.6 cases per 100,000 people and was reported from 10 countries. The overall mean proportion of IE patients that developed stroke was 0.158 ± 0.091, and the mean proportion of patients that underwent valve surgery was 0.324 ± 0.188. The mean case fatality risk was 0.211 ± 0.104. A systematic review for the GBD 2010 study provided IE epidemiology estimates for many world regions, but highlighted the lack of information about IE in low- and middle-income regions. More complete knowledge of the global burden of IE will require improved IE surveillance in all world regions.
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Affiliation(s)
- Aref A Bin Abdulhak
- Department of Medicine, School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Larry M Baddour
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | | | - Bruno Hoen
- Department of Infectious Diseases, Dermatology, and Internal Medicine, University Medical Center of Guadeloupe, Cedex, France
| | - Vivian H Chu
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - George A Mensah
- Center for Translation Research and Implementation Science (CTRIS), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Imad M Tleyjeh
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA; Division of Epidemiology, Mayo Clinic, Rochester, MN, USA; Department of Medicine, Infectious Diseases Section, King Fahad Medical City, Riyadh, Saudi Arabia; College of Medicine, Al Faisal University, Riyadh, Saudi Arabia.
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243
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Erwin JP, O’Gara P. Prognostic Assessment of Infective Endocarditis Using Echocardiography. Circ Cardiovasc Imaging 2015; 8:e003791. [DOI: 10.1161/circimaging.115.003791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- John P. Erwin
- From the Department of Internal Medicine, Texas A&M College of Medicine/Baylor Scott & White Health, Temple (J.P.E.); and Department of Internal Medicine, Division of Cardiology, Harvard Medical School/Brigham and Women’s Hospital, Boston, MA (P.O’G.)
| | - Patrick O’Gara
- From the Department of Internal Medicine, Texas A&M College of Medicine/Baylor Scott & White Health, Temple (J.P.E.); and Department of Internal Medicine, Division of Cardiology, Harvard Medical School/Brigham and Women’s Hospital, Boston, MA (P.O’G.)
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Tong SYC, Davis JS, Eichenberger E, Holland TL, Fowler VG. Staphylococcus aureus infections: epidemiology, pathophysiology, clinical manifestations, and management. Clin Microbiol Rev 2015; 28:603-61. [PMID: 26016486 PMCID: PMC4451395 DOI: 10.1128/cmr.00134-14] [Citation(s) in RCA: 2785] [Impact Index Per Article: 309.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Staphylococcus aureus is a major human pathogen that causes a wide range of clinical infections. It is a leading cause of bacteremia and infective endocarditis as well as osteoarticular, skin and soft tissue, pleuropulmonary, and device-related infections. This review comprehensively covers the epidemiology, pathophysiology, clinical manifestations, and management of each of these clinical entities. The past 2 decades have witnessed two clear shifts in the epidemiology of S. aureus infections: first, a growing number of health care-associated infections, particularly seen in infective endocarditis and prosthetic device infections, and second, an epidemic of community-associated skin and soft tissue infections driven by strains with certain virulence factors and resistance to β-lactam antibiotics. In reviewing the literature to support management strategies for these clinical manifestations, we also highlight the paucity of high-quality evidence for many key clinical questions.
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Affiliation(s)
- Steven Y C Tong
- Global and Tropical Health, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Joshua S Davis
- Global and Tropical Health, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Emily Eichenberger
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Thomas L Holland
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Vance G Fowler
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
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Dong Y, Huang J, Li G, Li L, Li W, Li X, Liu X, Liu Z, Lu Y, Ma A, Sun H, Wang H, Wen X, Xu D, Yang J, Zhang J, Zhao H, Zhou J, Zhu L, Committee Members:, Bai L, Cao K, Chen M, Chen M, Dai G, Ding W, Dong W, Fang Q, Fang W, Fu X, Gao W, Gao R, Ge J, Ge Z, Gu F, Guo Y, Han H, Hu D, Huang W, Huang L, Huang C, Huang D, Huo Y, Jin W, Ke Y, Lei H, Li X, Li Y, Li D, Li G, Li X, Li Z, Liang Y, Liao Y, Liu G, Ma A, Ma C, Ma D, Ma Y, Shen L, Sun J, Sun C, Sun Y, Tang Q, Wan Z, Wang H, Wang J, Wang S, Wang D, Wang G, Wang J, Wu Y, Wu P, Wu S, Wu X, Wu Z, Yang J, Yang T, Yang X, Yang Y, Yang Z, Ye P, Yu B, Yuan F, Zhang S, Zhang Y, Zhang R, Zhang Y, Zhang Y, Zhao S, Zhou X. Guidelines for the prevention, diagnosis, and treatment of infective endocarditis in adults: The Task Force for the Prevention, Diagnosis, and Treatment of Infective Endocarditis in Adults of Chinese Society of Cardiology of Chinese Medical Association, and of the Editorial Board of Chinese Journal of Cardiology. Eur Heart J Suppl 2015. [DOI: 10.1093/eurheartj/suv031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Behrouz R. Preoperative Cerebrovascular Evaluation in Patients With Infective Endocarditis. Clin Cardiol 2015; 38:439-42. [PMID: 25872491 DOI: 10.1002/clc.22400] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 02/01/2015] [Indexed: 11/11/2022] Open
Abstract
Approximately 12% to 40% of infective endocarditis patients experience cerebrovascular complications. One of the major clinical challenges in cerebrovascular medicine is management of infective endocarditis patients with cerebrovascular complications who require valve operations. Cerebrovascular specialists are often summoned to address appropriate preoperative brain imaging, timing of surgery, and estimation of the risk of perioperative cerebral embolization and hemorrhage. This article addresses these issues based on the available evidence.
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Affiliation(s)
- Réza Behrouz
- Division of Cerebrovascular Diseases, Department of Neurology, Ohio State University College of Medicine, Columbus, Ohio
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Leontyev S, Davierwala PM, Krögh G, Feder S, Oberbach A, Bakhtiary F, Misfeld M, Borger MA, Mohr FW. Early and late outcomes of complex aortic root surgery in patients with aortic root abscesses. Eur J Cardiothorac Surg 2015; 49:447-54; discussion 454-5. [DOI: 10.1093/ejcts/ezv138] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 02/19/2015] [Indexed: 11/13/2022] Open
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Tribak M, Konaté M, Elhassani A, Mahfoudi L, Jaabari I, Elkenassi F, Boutayeb A, Lachhab F, Filal J, Maghraoui A, Bensouda A, Marmade L, Moughil S. [Aortic infective endocarditis: Value of surgery. About 48 cases]. Ann Cardiol Angeiol (Paris) 2015; 65:15-20. [PMID: 25813653 DOI: 10.1016/j.ancard.2015.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 02/12/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Infective endocarditis (IE) is a serious disease whose prognosis depends on early management. Aortic location is characterized by its evolution toward myocardial failure and the high number of complications reasons for early surgery. AIM To compare the short- and mid-terms results of surgery for aortic infective endocarditis (IE) in the active phase and the healed phase. PATIENTS AND METHODS We analyzed retrospectively the data of 48 consecutive patients operated for aortic infective endocarditis between January 2000 and January 2012. The data on operative mortality, morbidity and major cardiovascular events (mortality, recurrent endocarditis, reintervention, and stroke) were analyzed. RESULTS Twenty-three patients (48%) underwent surgery during the active phase (group I), 19 on native and 4 on prosthetic valves, and 25 patients (52%) were operated during healed endocarditis (group II) only on native valve. Mean age was 39 years (12-81) with a male predominance (83%). Rheumatic valvular disease was the main etiology of underlying valvular disease in both groups (85%). The clinical feature was dominated by signs of cardiogenic shock in group I and dyspnea exertion stage III-IV NYHA in group II. Streptococcus and Staphylococcus germs were most frequently encountered. Indication for surgery was heart failure in group I, it was related to the symptoms, the severity of valvular disease and its impact on the left ventricle in group II. An aortic valve replacement with a mechanical prosthesis was performed in the majority of cases (83%). Postoperative mortality concerned only one patient in group I. Twenty-one patients (44%) were followed for a mean of 30 months (1-72). One patient in group II died following cerebral hemorrhagic stroke related to accident with vitamin K antagonist. In both groups, there was an improvement in the functional class. No recurrence of endocarditis was noted in both groups during follow-up. CONCLUSION The prognosis of infective endocarditis of the aortic valve is severe due to the fast progression to heart failure. Early medical and surgical approach provides good results on morbidity and mortality in the short- and mid-terms.
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Affiliation(s)
- M Tribak
- Service de chirurgie cardiovasculaire B, hôpital Ibn Sina, Rabat, Maroc.
| | - M Konaté
- Service de cardiologie A, hôpital Ibn Sina, Rabat, Maroc
| | - A Elhassani
- Service de chirurgie cardiovasculaire B, hôpital Ibn Sina, Rabat, Maroc
| | - L Mahfoudi
- Service de chirurgie cardiovasculaire B, hôpital Ibn Sina, Rabat, Maroc
| | - I Jaabari
- Service de chirurgie cardiovasculaire B, hôpital Ibn Sina, Rabat, Maroc
| | - F Elkenassi
- Service de chirurgie cardiovasculaire B, hôpital Ibn Sina, Rabat, Maroc
| | - A Boutayeb
- Service de chirurgie cardiovasculaire B, hôpital Ibn Sina, Rabat, Maroc
| | - F Lachhab
- Service de chirurgie cardiovasculaire B, hôpital Ibn Sina, Rabat, Maroc
| | - J Filal
- Service de chirurgie cardiovasculaire B, hôpital Ibn Sina, Rabat, Maroc
| | - A Maghraoui
- Service de chirurgie cardiovasculaire B, hôpital Ibn Sina, Rabat, Maroc
| | - A Bensouda
- Service de chirurgie cardiovasculaire B, hôpital Ibn Sina, Rabat, Maroc
| | - L Marmade
- Service de chirurgie cardiovasculaire B, hôpital Ibn Sina, Rabat, Maroc
| | - S Moughil
- Service de chirurgie cardiovasculaire B, hôpital Ibn Sina, Rabat, Maroc
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Meshaal MS, Kassem HH, Samir A, Zakaria A, Baghdady Y, Rizk HH. Impact of routine cerebral CT angiography on treatment decisions in infective endocarditis. PLoS One 2015; 10:e0118616. [PMID: 25823006 PMCID: PMC4379076 DOI: 10.1371/journal.pone.0118616] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 01/21/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Infective endocarditis (IE) is commonly complicated by cerebral embolization and hemorrhage secondary to intracranial mycotic aneurysms (ICMAs). These complications are associated with poor outcome and may require diagnostic and therapeutic plans to be modified. However, routine screening by brain CT and CT angiography (CTA) is not standard practice. We aimed to study the impact of routine cerebral CTA on treatment decisions for patients with IE. METHODS From July 2007 to December 2012, we prospectively recruited 81 consecutive patients with definite left-sided IE according to modified Duke's criteria. All patients had routine brain CTA conducted within one week of admission. All patients with ICMA underwent four-vessel conventional angiography. Invasive treatment was performed for ruptured aneurysms, aneurysms ≥ 5 mm, and persistent aneurysms despite appropriate therapy. Surgical clipping was performed for leaking aneurysms if not amenable to intervention. RESULTS The mean age was 30.43 ± 8.8 years and 60.5% were males. Staph aureus was the most common organism (32.3%). Among the patients, 37% had underlying rheumatic heart disease, 26% had prosthetic valves, 23.5% developed IE on top of a structurally normal heart and 8.6% had underlying congenital heart disease. Brain CT/CTA revealed that 51 patients had evidence of cerebral embolization, of them 17 were clinically silent. Twenty-six patients (32%) had ICMA, of whom 15 were clinically silent. Among the patients with ICMAs, 11 underwent endovascular treatment and 2 underwent neurovascular surgery. The brain CTA findings prompted different treatment choices in 21 patients (25.6%). The choices were aneurysm treatment before cardiac surgery rather than at follow-up, valve replacement by biological valve instead of mechanical valve, and withholding anticoagulation in patients with prosthetic valve endocarditis for fear of aneurysm rupture. CONCLUSIONS Routine brain CT/CTA resulted in changes in the treatment plan in a significant proportion of patients with IE, even those without clinically evident neurological disease. Routine brain CT/CTA may be indicated in all hospitalized patients with IE.
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Affiliation(s)
| | | | - Ahmad Samir
- Department of Cardiovascular Medicine, Cairo University, Cairo, Egypt
| | - Ayman Zakaria
- Department of Radiology, Cairo University, Cairo, Egypt
| | - Yasser Baghdady
- Department of Cardiovascular Medicine, Cairo University, Cairo, Egypt
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Association of mean platelet volume level with in-hospital major adverse events in infective endocarditis. Wien Klin Wochenschr 2015; 127:197-202. [PMID: 25777146 DOI: 10.1007/s00508-015-0746-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 01/20/2015] [Indexed: 10/23/2022]
Abstract
We hypothesised that increased on-admission and follow-up mean platelet volume (MPV) levels would correlate with adverse outcomes in patients with infective endocarditis (IE). A total of 108 consecutive patients were grouped into two according to median MPV level (≤ 8.6 and > 8.6 fL). Patients with MPV level of > 8.6 fL had a significantly higher rate of end-stage renal disease, Staphylococcus aureus infection, higher CRP levels, embolic events and in-hospital mortality compared to patients with MPV levels ≤ 8.6 fL. In multivariable Cox regression analysis, previous history of IE, S. aureus infection, end-stage renal disease, depressed LVEF, early surgical intervention, vegetation size ≥ 10 mm, presence of perivalvular abscess, higher on-admission platelet count, CRP and MPV levels emerged as independent predictors of in-hospital unfavourable outcomes. Patients with embolic events and in-hospital mortality revealed an incremental trend for MPV levels compared to patients without any adverse events. Our study results suggest that both on-admission and follow-up MPV levels may be a simple and available biomarker for risk stratification of IE patients.
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