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Carrillo AJ, Rivera P, Walker RT, Farina LL, Benjamin EJ. Aorto-left atrial fistula secondary to aortic infective endocarditis in a dog with a bicuspid aortic valve. J Vet Cardiol 2024; 53:13-19. [PMID: 38565003 DOI: 10.1016/j.jvc.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 04/04/2024]
Abstract
An 11-year-old male neutered American bulldog was presented for evaluation of thrombocytopenia, acute onset of ataxia, and vomiting. A new murmur was auscultated on physical examination. Transthoracic echocardiographic examination revealed a bicuspid aortic valve, vegetative lesions on the aortic valve, and continuous shunting from the aortic root to the left atrium through an aorta to left atrial fistula. The dog was euthanized due to its guarded prognosis and critical condition. Pathological examination confirmed presence of a bicuspid aortic valve, aorto-left atrial fistula, and aortic infective endocarditis. Antemortem blood culture revealed two unusual organisms: Achromobacter xylosoxidans and Fusobacterium mortiferum.
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Affiliation(s)
- A J Carrillo
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, 2015 SW 16th Ave, PO Box 100116, Gainesville, FL 32610-0116, USA
| | - P Rivera
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, 2015 SW 16th Ave, PO Box 100116, Gainesville, FL 32610-0116, USA
| | - R T Walker
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, 2015 SW 16th Ave, PO Box 100123, Gainesville, FL 32610-0123, USA
| | - L L Farina
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, 2015 SW 16th Ave, PO Box 100123, Gainesville, FL 32610-0123, USA
| | - E J Benjamin
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, 2015 SW 16th Ave, PO Box 100116, Gainesville, FL 32610-0116, USA.
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Romito G, Diana A, Rigillo A, Morini M, Cipone M. Unusual Presentation of Aortic Valve Infective Endocarditis in a Dog: Aorto-Cavitary Fistula, Tricuspid Valve Endocarditis, and Third-Degree Atrioventricular Block. Animals (Basel) 2021; 11:ani11030690. [PMID: 33806631 PMCID: PMC7998688 DOI: 10.3390/ani11030690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/27/2021] [Accepted: 02/28/2021] [Indexed: 11/23/2022] Open
Abstract
Simple Summary In dogs, infective endocarditis represents a rare but clinically relevant disease that typically involves the aortic and/or mitral valve. Transthoracic echocardiography plays an essential role in the diagnosis, prognosis, and monitoring of such a condition. Typical echocardiographic signs of disease progression include left-sided cardiac dilatation and extension of aortic and/or mitral vegetative lesions. Nevertheless, unexpected complications can sometimes develop, especially in the case of the erosion of the periannular tissue caused by lytic enzymes produced by bacteria. This case report describes the coexistence of multiple, uncommon complications of aortic valve infective endocarditis in a dog, namely, aorto-cavitary fistula, tricuspid valve endocarditis and third-degree atrioventricular block. In this study, the combination of the ante mortem (clinical and echocardiographic) and post mortem (gross pathology and histopathology) findings allowed us to gain detailed information on the disease process, its atypical complications, and the associated emodynamic consequences. Abstract A 2-year-old Boxer with a history of subaortic stenosis and immunosuppressant therapy developed aortic valve infective endocarditis. On echocardiographic examination with simultaneous electrocardiographic tracing, multiple uncommon periannular complications of the aortic valve endocarditis were found, including aorto-cavitary fistula with diastolic left-to-right shunt, tricuspid valve endocarditis, and third-degree atrioventricular block. Necropsy confirmed the above echocardiographic findings. Although aortic valve endocarditis represents a well-known disease entity in dogs, the dynamic nature of this condition may allow development of complex and uncommon echocardiographic features.
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Gerrah R, Bardo DM, Reed RD, Sunstrom RE, Langley SM. Adjustment of the Surgical Plan in Repair of Congenital Heart Disease: The Power of Cross-sectional Imaging and Three-dimensional Visualization. CONGENIT HEART DIS 2013; 9:E31-6. [DOI: 10.1111/chd.12062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/01/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Rabin Gerrah
- Department of Surgery; Division of Pediatric Cardiac Surgery; Oregon Health and Science University; Doernbecher Children's Hospital; Portland Ore USA
| | - Dianna M.E. Bardo
- Department of Radiology; Oregon Health and Science University; Portland Ore USA
| | - Rich D. Reed
- Department of Surgery; Division of Pediatric Cardiac Surgery; Oregon Health and Science University; Doernbecher Children's Hospital; Portland Ore USA
| | - Rachel E. Sunstrom
- Department of Surgery; Division of Pediatric Cardiac Surgery; Oregon Health and Science University; Doernbecher Children's Hospital; Portland Ore USA
| | - Stephen M. Langley
- Department of Surgery; Division of Pediatric Cardiac Surgery; Oregon Health and Science University; Doernbecher Children's Hospital; Portland Ore USA
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Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA, Del Nido P, Fasules JW, Graham TP, Hijazi ZM, Hunt SA, King ME, Landzberg MJ, Miner PD, Radford MJ, Walsh EP, Webb GD. ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2009; 52:e143-e263. [PMID: 19038677 DOI: 10.1016/j.jacc.2008.10.001] [Citation(s) in RCA: 977] [Impact Index Per Article: 65.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA, del Nido P, Fasules JW, Graham TP, Hijazi ZM, Hunt SA, King ME, Landzberg MJ, Miner PD, Radford MJ, Walsh EP, Webb GD. ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: Executive Summary. Circulation 2008; 118:2395-451. [DOI: 10.1161/circulationaha.108.190811] [Citation(s) in RCA: 490] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA, del Nido P, Fasules JW, Graham TP, Hijazi ZM, Hunt SA, King ME, Landzberg MJ, Miner PD, Radford MJ, Walsh EP, Webb GD. ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease. Circulation 2008; 118:e714-833. [PMID: 18997169 DOI: 10.1161/circulationaha.108.190690] [Citation(s) in RCA: 624] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Affiliation(s)
- Jamil Aboulhosn
- Department of Medicine, Division of Cardiology, UCLA Medical Center, Los Angeles, CA 90095, USA
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Khairy P, Landzberg MJ, Gatzoulis MA, Mercier LA, Fernandes SM, Côté JM, Lavoie JP, Fournier A, Guerra PG, Frogoudaki A, Walsh EP, Dore A. Transvenous Pacing Leads and Systemic Thromboemboli in Patients With Intracardiac Shunts. Circulation 2006; 113:2391-7. [PMID: 16702467 DOI: 10.1161/circulationaha.106.622076] [Citation(s) in RCA: 203] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND The risk of systemic thromboemboli associated with transvenous leads in the presence of an intracardiac shunt is currently unknown. METHODS AND RESULTS To define this risk, we conducted a multicenter, retrospective cohort study of 202 patients with intracardiac shunts: Sixty-four had transvenous leads (group 1), 56 had epicardial leads (group 2), and 82 had right-to-left shunts but no pacemaker or implantable cardioverter defibrillator leads (group 3). Patient-years were accrued until the occurrence of systemic thromboemboli or study termination. Censoring occurred in the event of complete shunt closure, death, or loss to follow-up. Mean ages for groups 1, 2, and 3 were 33.9+/-18.0, 22.2+/-12.6, and 22.9+/-15.0 years, respectively. Respective oxygen saturations were 91.2+/-9.1%, 88.1+/-8.1%, and 79.7+/-6.7%. During respective median follow-ups of 7.3, 9.3, and 17.0 years, 24 patients had at least 1 systemic thromboembolus: 10 (15.6%), 5 (8.9%), and 9 (11.0%) in groups 1, 2, and 3, respectively. Univariate risk factors were older age (hazard ratio [HR], 1.05; P=0.0001), ongoing phlebotomy (HR, 3.1; P=0.0415), and an transvenous lead (HR, 2.4; P=0.0421). In multivariate, stepwise regression analyses, transvenous leads remained an independent predictor of systemic thromboemboli (HR, 2.6; P=0.0265). In patients with transvenous leads, independent risk factors were older age (HR, 1.05; P=0.0080), atrial fibrillation or flutter (HR, 6.7; P=0.0214), and ongoing phlebotomy (HR, 14.4; P=0.0349). Having had aspirin or warfarin prescribed was not protective. Epicardial leads were, however, associated with higher atrial (P=0.0407) and ventricular (P=0.0270) thresholds and shorter generator longevity (HR, 1.9; P=0.0176). CONCLUSIONS Transvenous leads incur a >2-fold increased risk of systemic thromboemboli in patients with intracardiac shunts.
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Affiliation(s)
- Paul Khairy
- Adult Congenital Heart and Electrophysiology Services, Montreal Heart Institute, Montreal, Canada.
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Ananthasubramaniam K. Patent ductus arteriosus in elderly patients: clinical and echocardiographic features-a case-based review. J Am Soc Echocardiogr 2001; 14:321-4. [PMID: 11287900 DOI: 10.1067/mje.2001.109684] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Congenital heart disease in adults is a rapidly growing field, with many operated and unoperated infants and children surviving into adulthood. Patent ductus arteriosus is an example of a congenital cardiac defect, which may enable patients to survive well into adulthood without prior recognition or correction before symptoms arise. This case illustrates the clinical and echocardiographic manifestations of patent ductus arteriosus with special emphasis on its 2-dimensional and Doppler findings. Management options for this condition are also briefly addressed.
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Sánchez M, García-Robles R, Morán E, Leiva A, Teijelo A, Jiménez-Martín F, Tejerizo-García A, Corredera F, Pérez-Escanilla J, Tejerizo-López L. Coartación aórtica diagnosticada después de un embarazo que cursó con hipertensión. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2001. [DOI: 10.1016/s0210-573x(01)77085-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
The average life expectancy of patients with congenital heart disease has dramatically improved over the past four decades because of advances in medical and surgical therapy, with patients with complex lesions surviving to adolescence and adulthood. Tetralogy of Fallot, transposition of the great arteries, ventricular septal defects, patent ductus, and bicuspid aortic valves in particular are susceptible to infective endocarditis. Most operated patients are left with some form of residua or sequelae, many of which predispose to infective endocarditis. Surgical palliation, such as systemic-to-pulmonary shunts, and reparative surgery, often requiring prosthetic valve or conduit replacement, are major predisposing conditions. Accordingly, recognition, prevention, and treatment strategies for infective endocarditis assume increasing importance in adolescents and adults with congenital heart disease, operated or not.
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Affiliation(s)
- H Dodo
- Division of Cardiology, National Children's Hospital, Tokyo, Japan
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CHILD JOHNS. Echocardiographic Evaluation of Adult Postoperative Congenital Heart Disease. Echocardiography 1995. [DOI: 10.1111/j.1540-8175.1995.tb00844.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Affiliation(s)
- J D Kaplan
- Division of Cardiology, University of California, San Francisco 94143-0214
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Abstract
Advances in medical and surgical management of congenital heart disease in the last three decades have resulted in a great many survivors to adulthood. Proper care requires intimate knowledge of the basic malformations and their surgical anatomy and results. Tetralogy of Fallot, the most common cyanotic malformation in adults, represents a spectrum from mild right ventricular outflow tract obstruction to complete pulmonary atresia. Evaluation of surgical residua and sequelae includes imaging of aortic-to-pulmonary arterial palliative shunts, detection of residual ventricular septal defect patch leaks or right ventricular outflow tract obstruction, definition of extracardiac conduit patency, and quantitation of ventricular function and valvular regurgitation. Refined echocardiographic imaging and hemodynamic definition is a mainstay in precise segmental anatomical and hemodynamic assessment. Transesophageal echocardiography is particularly important for intraoperative evaluation of surgical results.
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Affiliation(s)
- J S Child
- Division of Cardiology, UCLA Adult Congenital Heart Disease Center, University of California, Los Angeles, School of Medicine, 90024
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