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Spanneut TA, Paquet P, Bauters C, Modine T, Richardson M, Bonello L, Juthier F, Lemesle G. Utility and safety of coronary angiography in patients with acute infective endocarditis who required surgery. J Thorac Cardiovasc Surg 2020; 164:905-913.e19. [PMID: 33131891 DOI: 10.1016/j.jtcvs.2020.08.117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 08/09/2020] [Accepted: 08/15/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To assess the benefit/risk ratio to perform a coronary angiography (CA) before surgery for infective endocarditis (IE). METHODS We conducted a single-center prospective registry including 272 patients with acute IE intended for surgery and compared patients who underwent a preoperative CA (n = 160) with those who did not (n = 112). A meta-analysis of 3 observational studies was also conducted and included 551 patients: 342 who underwent a CA and 209 who did not. RESULTS In our registry, combined bypass surgery (CABG) was performed in 17% of the patients with preoperative CA. At 2 years, the rate of the primary composite end point (all-cause death, new systemic embolism, stroke, new hemodialysis) was similar in the CA (38%) and no-CA (37%) groups. In-hospital and 2-year individual end points were all similar between groups. There were only 2 episodes of systemic embolism after CA and only one possibly related to a vegetation dislodgement. In the meta-analysis, combined CABG was performed in 18% of the patients with preoperative CA. All-cause death was similar in both groups: odds ratio, 0.98 [0.62-1.53], P = .92. Only 5 cases of systemic embolism possibly related to a vegetation dislodgement were reported. New hemodialysis was numerically more frequent in the CA group: odds ratio, 1.68 [0.79-3.58] (18% vs 14%, P = .18). CONCLUSIONS In daily practice, two-thirds of the patients with acute IE who required surgery have a preoperative CA leading to a combined CABG in 18% of the patients. Our results suggest that to perform a preoperative CA in this context is not associated with improved prognosis.
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Affiliation(s)
- Théo-Alexandre Spanneut
- USIC et Centre Hémodynamique, Institut Coeur Poumon, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Pierre Paquet
- USIC et Centre Hémodynamique, Institut Coeur Poumon, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Christophe Bauters
- Service de Cardiologie, Institut Coeur Poumon, Centre Hospitalier Universitaire de Lille, Lille, France; INSERM UMR 1067, Institut Pasteur de Lille, Lille, France; Faculté de Médecine de l'Université de Lille, Lille, France
| | - Thomas Modine
- Service de chirurgie cardiaque et vasculaire, Institut Coeur Poumon, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Marjorie Richardson
- Service d'exploration fonctionnelle cardiovasculaire, Institut Coeur Poumon, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Laurent Bonello
- Service de Cardiologie, Hopital Nord de Marseille, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - Francis Juthier
- Faculté de Médecine de l'Université de Lille, Lille, France; Service de chirurgie cardiaque et vasculaire, Institut Coeur Poumon, Centre Hospitalier Universitaire de Lille, Lille, France; INSERM UMR 1011, Institut Pasteur de Lille, Lille, France
| | - Gilles Lemesle
- USIC et Centre Hémodynamique, Institut Coeur Poumon, Centre Hospitalier Universitaire de Lille, Lille, France; Faculté de Médecine de l'Université de Lille, Lille, France; INSERM UMR 1011, Institut Pasteur de Lille, Lille, France; FACT (French Alliance for Cardiovascular Trials), Paris, France.
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Faluk MA, Vuu S, Kathi K, Abdelmaseih R, Cignoni C, Tarasiuk-Rusek A, Prashad R, Osian O. Challenges in Managing Acute Myocardial Infarction Associated With Infective Endocarditis: A Case Report. J Investig Med High Impact Case Rep 2020; 8:2324709620960001. [PMID: 32935586 PMCID: PMC7498957 DOI: 10.1177/2324709620960001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Acute myocardial infarction (AMI) is a rare but recognized and potentially serious
complication of infective endocarditis (IE). This case describes the challenges
surrounding the management of AMI in the setting of septic coronary embolism, brain,
spleen, and kidney infarcts due to septic emboli from native mitral valve IE.
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Affiliation(s)
- Mohammed Ali Faluk
- University of Central Florida, Orlando, FL, USA.,Ocala Regional Medical Center, Ocala, FL, USA
| | - Steven Vuu
- University of Central Florida, Orlando, FL, USA.,Ocala Regional Medical Center, Ocala, FL, USA
| | - Kiran Kathi
- University of Central Florida, Orlando, FL, USA.,Ocala Regional Medical Center, Ocala, FL, USA
| | - Ramy Abdelmaseih
- University of Central Florida, Orlando, FL, USA.,Ocala Regional Medical Center, Ocala, FL, USA
| | - Christian Cignoni
- University of Central Florida, Orlando, FL, USA.,Ocala Regional Medical Center, Ocala, FL, USA
| | - Aneta Tarasiuk-Rusek
- University of Central Florida, Orlando, FL, USA.,Ocala Regional Medical Center, Ocala, FL, USA
| | - Rakesh Prashad
- University of Central Florida, Orlando, FL, USA.,Ocala Regional Medical Center, Ocala, FL, USA
| | - Omeni Osian
- University of Central Florida, Orlando, FL, USA.,Ocala Regional Medical Center, Ocala, FL, USA
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The Role of Coronary Catheterization with Angiography in Surgically Managed Infectious Endocarditis. Am J Med 2020; 133:1101-1104. [PMID: 31972147 DOI: 10.1016/j.amjmed.2019.12.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 12/11/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Coronary catheterization with angiography is often performed prior to surgical valve replacement in infectious endocarditis. There are no existing data as to whether this intervention is clinically necessary or leads to a change in surgical management. In order to determine the frequency with which coronary angiography impacts surgical management in infectious endocarditis, we conducted a retrospective review of surgically managed endocarditis cases at a tertiary care medical center. METHODS Utilizing the institutional Society of Thoracic Surgeon's database, we identified 598 patients with surgically managed endocarditis between April 29, 2011 and December 31, 2018. Patient variables were recorded, including risk factors for coronary artery disease, whether the patient received coronary angiography prior to surgery, and if the patient underwent coronary artery bypass grafting as part of their valve surgery. RESULTS There were 430 patients who received coronary catheterization with angiography prior to surgical valve replacement for infectious endocarditis, and 168 patients proceeded to surgery without coronary angiography. Nine percent of patients underwent coronary artery bypass grafting at the time of valve replacement as a result of coronary angiography findings. There was no significant difference in 30-day mortality for patients with endocarditis who underwent coronary angiography when compared with those who did not receive coronary angiography (2.6 vs 2.4%; P = 0.89). CONCLUSIONS Left heart catheterization with coronary angiography prior to surgical valve replacement leads to coronary artery bypass grafting in the minority of infective endocarditis patients.
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4
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Abstract
Acute aortic regurgitation usually results from infective endocarditis, but is also caused by aortic dissection and trauma to the heart. Most of the left ventricular stroke volume is regurgitated back into the left ventricle; thus, the forward stroke volume to the body and the cardiac output may be severely compromised. An acute increase in left ventricular end-diastolic volume results in a marked increase in left ventricular end-diastolic pressure, and the mitral valve usually closes prematurely. Compensatory tachycardia is the rule and helps to shorten diastole; thus, the time available for aortic regurgitation to occur is reduced, and the cardiac output is often maintained. On physical examination, there is tachycardia; the peripheral arterial pulse shows a rapid rise, but the systolic pressure is normal; the diastolic pressure is normal or even reduced; and the pulse pressure is often normal. The electrocardiogram (ECG) may be normal except for sinus tachycardia and often for nonspecific ST-T changes. The chest roentgenogram usually shows signs of pulmonary venous hypertension or even pulmonary edema. Echocardiography may show vegetations on the aortic valve, prolapse of an aortic leaflet into the left ventricle, and premature mitral valve closure. Doppler echocardiography is useful in detecting the presence of aortic regurgitation. In cases of infective endocarditis, the appropriate antibiotic therapy must be given. Aortic regurgitation due to dissection of the aorta is usually an indication for surgery. In patients with severe aortic regurgitation, available medical therapy includes digitalis, diuretics, and vasodilators. When patients respond dramatically to the use of digitalis, diuretics, and arterial dilators, surgical therapy can be delayed until heart failure and infection are controlled and the patient is more stable. If the patient does not respond immediately and dramatically to therapy, then valve replacement should not be delayed, even if the infection is uncontrolled or the patient has had little antibiotic therapy.
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Affiliation(s)
- Robert A. O'Rourke
- From The Division of Cardiology, Department of Medicine, University of Texas, Health Science Center, San Antonio, TX 78284
| | - Richard A. Walsh
- From The Division of Cardiology, Department of Medicine, University of Texas, Health Science Center, San Antonio, TX 78284
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Açar G, Ozkok A, Dönmez C, Avcı A, Alizade E, Yanartaş M. Myocardial infarction due to septic coronary artery embolism in the course of Brucella endocarditis. Herz 2014; 40:335-7. [PMID: 24609796 DOI: 10.1007/s00059-013-4011-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 10/18/2013] [Accepted: 10/21/2013] [Indexed: 11/24/2022]
Affiliation(s)
- G Açar
- Department of Cardiology, Kartal Kosuyolu High Specialty Education and Research Hospital, Denizer Street, Cevizli Kavsagi, No. 2, 34846, Kartal/Istanbul, Turkey,
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Okai I, Inoue K, Yamaguchi N, Makinae H, Maruyama S, Komatsu K, Kawano Y, Okazaki S, Fujiwara Y, Sumiyoshi M, Amano A, Daida H. Infective endocarditis associated with acute myocardial infarction caused by septic emboli. J Cardiol Cases 2009; 1:e28-e32. [PMID: 30615754 DOI: 10.1016/j.jccase.2009.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Revised: 05/30/2009] [Accepted: 06/10/2009] [Indexed: 10/20/2022] Open
Abstract
A 53-year-old Japanese man presented with severe chest pain. He had suffered from persistent fever, muscle pain, arthralgia, and dyspnea on exertion (New York Heart Association class I) for two and half months prior to admission. He had been treated with several antibiotics for two months and prednisolone for almost one month prior to admission. On the day of admission, he had suffered from chest pain at rest, and had come to our hospital. Electrocardiography showed a normal sinus rhythm with significant ST segment elevation in leads V3-6 and abnormal Q waves in leads V4-6. Transthoracic echocardiography demonstrated left ventricular ejection fraction of 52% with severe mitral regurgitation and an 18-mm vegetation on the anterior mitral valve leaflet. Multiple blood cultures identified Streptococcus sanguis. The diagnosis was acute myocardial infarction and mitral regurgitation associated with infective endocarditis (IE). The incidence of acute coronary syndrome caused by IE is quite low in patients with native valves. After a 6-week course of antibiotics, mitral valve replacement and partial cardiomyotomy were performed. Two years after the surgery, follow-up echocardiography showed almost normal left ventricle function and no mitral regurgitation, and the patient has been living an active life without any complications.
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Affiliation(s)
- Iwao Okai
- Department of Cardiology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima-ku, Tokyo 177-8521, Japan
| | - Kenji Inoue
- Department of Cardiology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima-ku, Tokyo 177-8521, Japan
| | - Naotaka Yamaguchi
- Department of Emergency and Intensive Care, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Haruka Makinae
- Department of Cardiovascular Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Sonomi Maruyama
- Department of Cardiology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima-ku, Tokyo 177-8521, Japan
| | - Kaoru Komatsu
- Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Yasunobu Kawano
- Department of Cardiology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Shinya Okazaki
- Department of Cardiology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima-ku, Tokyo 177-8521, Japan
| | - Yasumasa Fujiwara
- Department of Cardiology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima-ku, Tokyo 177-8521, Japan
| | - Masataka Sumiyoshi
- Department of Cardiology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima-ku, Tokyo 177-8521, Japan
| | - Atsushi Amano
- Department of Cardiovascular Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroyuki Daida
- Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan
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Chen Z, Ng F, Nageh T. An unusual case of infective endocarditis presenting as acute myocardial infarction. Emerg Med J 2007; 24:442-3. [PMID: 17513553 PMCID: PMC2658294 DOI: 10.1136/emj.2006.043000] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
A 39-year-old Zimbabwean man presented with a 1 week history of fever, general malaise and acute-onset chest pain. He had a urethral stricture, which had been managed with an indwelling supra-pubic catheter. The electrocardiography on admission showed inferior ST-T segments elevation. His chest pain and electrocardiography changes resolved subsequent to thrombolysis, and he remained haemodynamically stable. The 12-h troponin I was increased at 10.5 microg/l (NR <0.04 microg/l). Echocardiography confirmed severe mitral regurgitation and a flail anterior mitral valve leaflet with an independently oscillating mobile vegetation. Enterococci faecalis were grown on blood cultures. A diagnosis of enterococci infective endocarditis with concomitant acute myocardial infarction due to possible septic emboli was made. Despite the successful outcome from thrombolysis in the setting of acute myocardial infarction with infective endocarditis, the case highlights the current lack of definitive data on the optimal acute management of such an unusual clinical scenario. Although there is serious concern that thrombolytic treatment for myocardial infarction in the setting of infective endocarditis may be associated with higher risk of cerebral haemorrhage, there is little documented evidence supporting the safety of primary percutaneous coronary intervention with these patients.
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Affiliation(s)
- Zhong Chen
- Department of Cardiology, London Chest Hospital, Bonner Road, London E2 9JX, UK.
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8
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Carmen Manzano M, Vilacosta I, San Román JA, Aragoncillo P, Sarriá C, López D, López J, Revilla A, Manchado R, Hernández R, Rodríguez E. Síndrome coronario agudo en la endocarditis infecciosa. Rev Esp Cardiol 2007. [DOI: 10.1157/13097922] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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9
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Yankah AC, Klose H, Petzina R, Musci M, Siniawski H, Hetzer R. Surgical management of acute aortic root endocarditis with viable homograft: 13-year experience. Eur J Cardiothorac Surg 2002; 21:260-7. [PMID: 11825733 DOI: 10.1016/s1010-7940(01)01084-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Cryopreserved homograft valves have been used for acute infective aortic root endocarditis with great success but it is compounded by its availability in all sizes. The long-term clinical results of geometric mismatched homografts are not well defined and addressed. METHODS Over a 15-year period (April 1986-June 2001), 816 patients presented with active infective endocarditis. One hundred and eighty-two of the patients aged between 9 and 78 years (mean: 51.0 +/- 1.13 years) consisting of 142 males and 40 females received homograft aortic valves. One hundred and ten patients were in NYHA functional class III and 72 in class IV and in cardiogenic shock. Of the patients, 2.7% suffered from septic embolism. One hundred and twenty-four (68.1%) patients presented with periannular abscesses and 58 (31.9%) with no abscess while 107 native valve (NVE) and 75 prosthetic valve (PVE) endocarditis were diagnosed preoperatively by transesophageal echocardiography (TEE) and confirmed intraoperatively. Freehand subcoronary implantation (FSCI) was used in 106 patients and root replacement in 76 patients. RESULTS The operative death was 8.5% and for patients in NYHA functional class IV and in cardiogenic shock was 14.5%. Late mortality rate was 7.9%. Patient survival after discharge from hospital at 1 year was 97% and at 10 years was 91%, respectively. Thirty-one (22.1%) patients underwent reoperation after 1.7 years (mean) with two deaths (6.4%). Early (< or = 60 days) and late reinfection rate was 2.7 and 3.6%, respectively. Freedom from reoperation for matched and undersized homografts at 10-13 years was 85 and 55%, respectively. The univariate model identified undersized homograft (P=0.002), FSCI (P=0.09) and reinfection (P=0.0001) as independent risk factors for developing early and late valve dysfunction resulting in reoperation and homograft explant. CONCLUSION Early aggressive valve replacement with homograft for active infective aortic root endocarditis with periannular abscesses is more successful than delayed last resort surgery. Homografts exhibit excellent clinical performance and durability with a low rate of reinfection, if properly inserted. Undersized homograft is an incremental risk factor for early and late reoperation.
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Affiliation(s)
- A C Yankah
- Department of Cardiothoracic and Vascular Surgery, Humboldt University Berlin, Deutsches Herzzentrum Berlin, Augustenburger Platz 1 D-13353 Berlin, Germany.
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10
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Abstract
The use of thrombolytics in the management of acute myocardial infarction in eligible patients is the accepted standard of practice. We present the case of an embolic myocardial infarction in the setting of acute infectious endocarditis, treated with thrombolytics, resulting in a massive intracerebral hemorrhage and the patient's death. Historical and current literature has shown a consistent and significant incidence of concurrent intracerebral mycotic aneurysms in the setting of infectious endocarditis. Despite this, a literature review of contraindications to the use of thrombolytics rarely recognizes endocarditis as a contraindication. It is imperative that the etiology for myocardial infarction be identified; if contraindications to thrombolytic treatment exist, alternative therapeutic interventions must be pursued. This case highlights the importance of the correct etiologic diagnosis of myocardial ischemia, and increases the awareness of the significant risks of intracerebral hemorrhage associated with the use of thrombolytics in the setting of endocarditis.
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Affiliation(s)
- A J Hunter
- Department of Medicine, Oregon Health Sciences University, Portland, Oregon, USA
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11
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Shamsham F, Safi AM, Pomerenko I, Salciccioli L, Feit A, Clark LT, Alam M. Fatal left main coronary artery embolism from aortic valve endocarditis following cardiac catheterization. Catheter Cardiovasc Interv 2000; 50:74-7. [PMID: 10816286 DOI: 10.1002/(sici)1522-726x(200005)50:1<74::aid-ccd16>3.0.co;2-p] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Coronary artery embolization has been associated with sudden cardiac death. It is more commonly seen with aortic valve endocarditis. It manifests as acute myocardial ischemia or infarction, causing instability of the cardiac rhythm, which may be fatal. We report a patient with aortic valve endocarditis who had sudden cardiac death following coronary angiography. Autopsy revealed embolic occlusion of the left main coronary artery.
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Affiliation(s)
- F Shamsham
- Division of Cardiovascular Medicine, State University of New York Health Science Center at Brooklyn, New York 11203, USA
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Scanlon PJ, Faxon DP, Audet AM, Carabello B, Dehmer GJ, Eagle KA, Legako RD, Leon DF, Murray JA, Nissen SE, Pepine CJ, Watson RM, Ritchie JL, Gibbons RJ, Cheitlin MD, Gardner TJ, Garson A, Russell RO, Ryan TJ, Smith SC. ACC/AHA guidelines for coronary angiography. A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on Coronary Angiography). Developed in collaboration with the Society for Cardiac Angiography and Interventions. J Am Coll Cardiol 1999; 33:1756-824. [PMID: 10334456 DOI: 10.1016/s0735-1097(99)00126-6] [Citation(s) in RCA: 658] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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13
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Jaski BE, Branch KR, Dasse KA, Dembitsky WP. Diagnosis and treatment of complications in patients implanted with a TCI left ventricular assist device. J Interv Cardiol 1995; 8:275-82. [PMID: 10155239 DOI: 10.1111/j.1540-8183.1995.tb00545.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Currently used left ventricular assist devices allow chronic mechanical cardiac support in the patient with end-stage heart failure. Recognition and treatment of problems uniquely associated with this device may be increasingly important for the invasive cardiologist as application of this technology becomes more prevalent.
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Affiliation(s)
- B E Jaski
- San Diego Cardiac Center, Donald M. Sharp Memorial Hospital, CA 92123, USA
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14
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Jault F, Gandjbakhch I, Chastre J, Levasseur J, Bors V, Gibert C, Pavie A, Cabrol C. Prosthetic valve endocarditis with ring abscesses. J Thorac Cardiovasc Surg 1993. [DOI: 10.1016/s0022-5223(19)33785-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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15
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Abstract
A case of endocarditis caused by Propionibacterium acnes associated with an aortic root abscess is presented. This supports the current opinion that aortic root abscesses are not necessarily associated with microorganisms of high virulence.
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Affiliation(s)
- S M Horner
- Department of Cardiology, Middlesex Hospital, London
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Affiliation(s)
- A R Bhagwat
- Department of Cardiology and Cardiothoracic Surgery, B. Y. L. Nair Charitable Hospital, Bombay, India
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18
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Wickline CL, Goli VD, Buell JC. Coronary artery narrowing due to extrinsic compression by myocardial abscess. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1991; 23:121-3. [PMID: 2070397 DOI: 10.1002/ccd.1810230212] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A case of aortic valve endocarditis complicated by perivalvular abscess extending into myocardium is presented. Echocardiography and aortography failed to detect the abscess, but coronary angiography revealed its presence by extrinsic compression of left anterior descending and diagonal arteries. Morphological features of this rare cause for coronary narrowing are described.
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Affiliation(s)
- C L Wickline
- Texas Tech University Health Sciences Center, Internal Medicine Department, Lubbock 79430
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Abstract
Cardiac involvement in AIDS may occur at any stage of HIV disease and may manifest as congestive cardiomyopathy, potentially lethal arrhythmia, or pericardial effusion and tamponade. The heart may be affected by nearly all of the opportunistic infections and many of the malignancies associated with the syndrome. Although often clinically unobtrusive, cardiac lesions may be important in the pathogenesis of significant clinical symptoms and play an often unrecognized role in the prognosis and natural history of AIDS.
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Affiliation(s)
- C K Francis
- College of Physicians and Surgeons of Columbia University, New York, New York
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20
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Heimberger TS, Duma RJ. Infections of Prosthetic Heart Valves and Cardiac Pacemakers. Infect Dis Clin North Am 1989. [DOI: 10.1016/s0891-5520(20)30260-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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21
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Akins EW, Limacher M, Slone RM, Hill JA. Evaluation of an aortic annular pseudoaneurysm by MRI: comparison with echocardiography, angiography and surgery. Cardiovasc Intervent Radiol 1987; 10:188-93. [PMID: 3115572 DOI: 10.1007/bf02593867] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Nuclear magnetic resonance imaging (MRI) was clinically useful in a case of aortic annular pseudoaneurysm complicating bacterial endocarditis. The MRI findings were proven by angiography and surgery. Although surgical correction was attempted, the aneurysm recurred and has been followed by MRI and two-dimensional echocardiography. In addition to two-dimensional echocardiography, MRI represents a useful noninvasive imaging method for diagnosis and follow up of aortic annular pseudoaneurysm.
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Affiliation(s)
- E W Akins
- Department of Radiology, University of Florida College of Medicine, Gainesville 32610
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23
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Ugolini V, Pacifico A, Smitherman TC, Mackowiak PA. Pneumococcal endocarditis update: analysis of 10 cases diagnosed between 1974 and 1984. Am Heart J 1986; 112:813-9. [PMID: 3766382 DOI: 10.1016/0002-8703(86)90479-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
We analyzed the clinical characteristics of 10 patients with pneumococcal endocarditis hospitalized between 1974 and 1984. Patients with pneumococcal endocarditis were typically middle-aged men. Forty percent were alcoholic. They sought medical attention early in the course of their illness and were given appropriate antibiotics promptly. The aortic valve was involved in seven patients. Five patients developed signs of severe valvular insufficiency, and congestive heart failure was present at the time of admission in four patients. Only three patients were recognized to have endocarditis prior to death or to the occurrence of a major complication of their infection. The total in-hospital mortality rate among these patients was 50%. Thus pneumococcal endocarditis is generally an acute, left-sided endocarditis that is associated with rapid valvular destruction and a high mortality rate. Unfortunately, recent advances in diagnosis and treatment of bacterial endocarditis have not substantially improved the outcome of this devastating infection.
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24
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Reid CL, Chandraratna PA, Rahimtoola SH. Infective endocarditis: improved diagnosis and treatment. Curr Probl Cardiol 1985; 10:1-50. [PMID: 3979094 DOI: 10.1016/s0146-2806(85)80001-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Fernandez GC, Chapman AJ, Bolli R, Rose SD, O'Meara ME, Luck JC, Pratt CM, Young JB. Gonococcal endocarditis: a case series demonstrating modern presentation of an old disease. Am Heart J 1984; 108:1326-34. [PMID: 6437201 DOI: 10.1016/0002-8703(84)90761-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Gonococcal endocarditis appeared with striking frequency in the preantibiotic era compared with its surprising rarity today. We present a series of four episodes of gonococcal endocarditis, which presented to our institution in the last 2 years, after no cases in the previous decade. Three episodes involved the aortic valve and required emergency aortic valve replacement. One episode involved the tricuspid valve and was successfully cured with antibiotic infusion alone. Combining our four patients with the available 25 well-documented gonococcal endocarditis cases reported in the English medical literature during the antibiotic era, we demonstrated that the disease incidence may be increasing, that infections more often involve left-sided cardiac structures (particularly the aortic valve), and that the association with a quotidian fever curve, rash and arthritis, and overt gonococcal infection is less common than previously reported. These patients frequently present with fulminant and dramatic valvular insufficiency without immediately positive blood cultures and complete echocardiographic evaluation seems to provide a valuable aid in making a presumptive diagnosis of endocarditis and directing appropriate clinical management.
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Silverman NA, Levitsky S, Mammana R. Acute endocarditis in drug addicts: surgical treatment for multiple valve infection. J Am Coll Cardiol 1984; 4:680-4. [PMID: 6481010 DOI: 10.1016/s0735-1097(84)80393-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
In 72 drug abusers surgically treated for acute infective endocarditis, 14 patients (19%) required surgical procedures on two valves. The predominant infecting organisms were Staphylococcus aureus and Pseudomonas aeruginosa (29%). In contrast to single valve infection, congestive heart failure was the most common operative indication (86%, p less than 0.05) and was uniformly present when both left-sided valves were involved. Surgery was performed 20 +/- 13 days after initiation of antibiotic therapy, yet 7 of the 14 patients had perivalvular abscess formation. In nine patients with solely left-sided infection, aortic and mitral valve replacements were performed. In five patients with bilateral infection, partial or complete tricuspid valvectomy was performed in conjunction with one aortic and four mitral valve replacements. Tricuspid valve competence was reestablished by valve insertion or anuloplasty in two patients, and these patients experienced less perioperative heart failure than did those with tricuspid excision alone. There was no early (less than 30 day) mortality. However, long-term follow-up revealed a reoperative incidence of 21% and a 36% late mortality rate due to prosthetic valve infection with or without dehiscence at 3 to 18 months (mean 7.2 +/- 6) after the initial operation. These late infectious complications were not related to infecting organism or prosthetic material in the tricuspid anulus, but did occur in four (57%) of seven patients with intracardiac abscess. The data indicate that multiple valve infection does not preclude successful early surgical therapy, maintaining tricuspid competence may be hemodynamically preferable, and reinfection in this addict population increases late mortality.
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Cheitlin MD, Mills J. Infective endocarditis. Is cardiac catheterization usually needed before cardiac surgery? Chest 1984; 86:4-6. [PMID: 6734290 DOI: 10.1378/chest.86.1.4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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DePace NL, Nestico PF, Kotler MN, Mintz GS, Kimbiris D, Goel IP, Glazier-Laskey EE, Ross J. Comparison of echocardiography and angiography in determining the cause of severe aortic regurgitation. BRITISH HEART JOURNAL 1984; 51:36-45. [PMID: 6689919 PMCID: PMC482308 DOI: 10.1136/hrt.51.1.36] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
To assess the accuracy of echocardiography in determining the cause of aortic regurgitation M mode and cross sectional echocardiography were compared with angiography in 43 patients with predominant aortic regurgitation. Each patient had all three investigations performed during the same admission to hospital. In each instance, the cause of aortic regurgitation was confirmed at surgery or necropsy. Seventeen patients had rheumatic aortic valve disease, 13 bacterial endocarditis with a perforated or partially destroyed cusp, five a bicuspid aortic valve (four with a history of endocarditis), and eight aortic regurgitation secondary to aortic root dilatation or aneurysm. Overall sensitivity of echocardiography and aortography was 84% in determining the cause of aortic regurgitation. Thus, rheumatic valve disease and endocarditis appear to be the most common causes of severe aortic regurgitation in this hospital based population. Furthermore, echocardiography is a sensitive non-invasive technique for determining the cause of aortic regurgitation and allows differentiation of valvular from root causes of aortic regurgitation.
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Hosenpud JD, Greenberg BH. The preoperative evaluation in patients with endocarditis. Is cardiac catheterization necessary? Chest 1983; 84:690-4. [PMID: 6641303 DOI: 10.1378/chest.84.6.690] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
We retrospectively compared clinical assessment and cardiac catheterization to subsequent surgical findings with regard to specific valvular involvement, hemodynamic status, and presence of myocardial abscess in patients recommended for cardiac surgery for endocarditis. Of 105 consecutive patients with endocarditis, 19 met one or more of the following criteria suggesting the need for early surgery: congestive heart failure; systemic emboli; persistent infections or new conduction abnormalities. Of these 19 patients, seven had prosthetic cardiac valves. Clinical assessment was highly sensitive (95 percent) and specific (89 percent) for specific valvular involvement and was also highly sensitive and specific in evaluating myocardial abscess and congestive heart failure; however, clinical assessment could not identify the source of infection in one patient with multiple prosthetic valves, did not define the specific valve in one patient with right-sided endocarditis, and overestimated the severity of mitral regurgitation in one patient who had normal pressures and flows at catheterization. Catheterization incorrectly predicted multivalvular involvement in four patients. At catheterization, only one patient experienced evidence of clinical deterioration, and this was probably not related to the procedure. We conclude that although clinical assessment is correct in most patients, it may on occasion lead to an erroneous conclusion. Catheterization and angiograms are of value in the preoperative evaluation of patients with endocarditis, particularly in cases where the clinical assessment is ambiguous or uncertain. The procedures can be performed at low risk, and the information obtained may substantially influence management in some cases.
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Croft CH, Woodward W, Elliott A, Commerford PJ, Barnard CN, Beck W. Analysis of surgical versus medical therapy in active complicated native valve infective endocarditis. Am J Cardiol 1983; 51:1650-5. [PMID: 6858871 DOI: 10.1016/0002-9149(83)90203-5] [Citation(s) in RCA: 125] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
From 1972 to 1980, 23 patients (Group A) with native valve infective endocarditis underwent surgical intervention, often for multiple indications, during the active stage of the infective process because of progressive class III and IV (New York Heart Association) heart failure (12 patients), persistent severe hypotension (3 patients), uncontrolled infection for over 21 days (11 patients), aortic root abscess (2 patients), and pericarditis (1 patient). Eighty-five patients (Group B) with active native valve endocarditis, matched for severity of illness, were treated medically. Two patients (9%) in Group A and 43 patients (51%) in Group B died during the hospital admission (p less than 0.001). Any difference in long-term cumulative survival rate between the 2 groups was largely due to the beneficial impact of surgical management on the hospital mortality. Of 23 patients in Group A, 11 (48%) had an entirely uncomplicated postoperative course. Long-term mortality rates in those with aortic valve endocarditis treated medically (79%) were significantly higher than in those with mitral valve involvement (47%) (p less than 0.05). Patients with aortic valve involvement treated surgically had a better hospital (p less than 0.005) and long-term (p less than 0.0005) survival rate than those treated medically. Two groups at risk for postoperative complications were identified; 3 of 11 patients (27%) with uncontrolled infection had an early postoperative recurrence, and 4 of 7 patients (57%) with an aortic root abscess had postoperative prosthetic paravalvular regurgitation. Surgery therefore effects a substantial reduction in hospital mortality in patients with complicated active infective endocarditis (9% versus 51%), but patients with preoperative prolonged periods of uncontrolled infection or with aortic root abscess are liable to postoperative complications.
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Pringle TH, Webb SM, Khan MM, O'Kane HO, Cleland J, Adgey AA. Clinical, echocardiographic, and operative findings in active infective endocarditis. Heart 1982; 48:529-37. [PMID: 7171398 PMCID: PMC482743 DOI: 10.1136/hrt.48.6.529] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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Abstract
Culture-negative endocarditis is not uncommon; the most frequent causes of the culture negative state are prior antibiotic therapy and problems with or inadequacies in bacteriologic technique. In addition to blood culture, studies that can aid in substantiating a presumptive diagnosis of infective endocarditis include echocardiography. Immunologic tests, and cardiac catheterization. Empiric antibiotic therapy often is necessary and should not be delayed to await positive blood cultures and results of antimicrobial sensitivity studies.
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Nakamura K, Suzuki S, Satomi G, Hayashi H, Hirosawa K. Detection of mitral ring abscess by two-dimensional echocardiography. Circulation 1982; 65:816-9. [PMID: 7060262 DOI: 10.1161/01.cir.65.4.816] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
M-mode and two-dimensional echocardiographic features of mitral ring abscess are described. A round, dense echo mass between the posterior mitral leaflet and left ventricular posterior wall was demonstrated in long- and short-axis views of the left ventricle. The diagnosis of mitral ring abscess was confirmed at surgery. The superiority of two-dimensional echocardiography over M-mode echocardiography for evaluating patients with mitral ring abscess is also discussed.
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Griffiths BE, Petch MC, English TA. Echocardiographic detection of subvalvar aortic root aneurysm extending to mitral valve annulus as complication of aortic valve endocarditis. BRITISH HEART JOURNAL 1982; 47:392-6. [PMID: 6895998 PMCID: PMC481152 DOI: 10.1136/hrt.47.4.392] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Acute aortic regurgitation as a consequence of infective endocarditis developed in a young man after peritonitis. A large subvalvar aortic root aneurysm extending to the mitral valve annulus together with features of severe acute aortic regurgitation were shown by M-mode echocardiography. The echocardiographic findings were confirmed at operation when obliteration of the aneurysmal space and aortic valve replacement were performed. Postoperative echocardiography confirmed obliteration of the aneurysmal space.
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Young JB, Raizner AE, Miller RR. Reply. Am J Cardiol 1981. [DOI: 10.1016/0002-9149(81)90241-1] [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]
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Walsh RA, O'Rourke RA. The diagnosis and management of acute left-sided valvular regurgitation. Curr Probl Cardiol 1979; 4:1-34. [PMID: 398247 DOI: 10.1016/0146-2806(79)90006-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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