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Mahamid M, Mashiah J, Rozner E, Jabaren M, Turgeman Y, Koren O. Right-Sided Endocarditis involving Eustachian Valve Following the Use of a Central Venous Line. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e923465. [PMID: 32925870 PMCID: PMC7518643 DOI: 10.12659/ajcr.923465] [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] [Indexed: 11/15/2022]
Abstract
Patient: Male, 27-year-old Final Diagnosis: Endocarditis Symptoms: Fever Medication: — Clinical Procedure: Transesophageal echocardiogram Specialty: Cardiology • Gastroenterology and Hepatology • Nephrology
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Affiliation(s)
| | - Jusinga Mashiah
- Department of Infectious Diseases, Emek Medical Center, Afula, Israel
| | - Ehud Rozner
- Heart Institute, Emek Medical Center, Afula, Israel
| | | | - Yoav Turgeman
- Heart Institute, Emek Medical Center, Afula, Israel.,Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ofir Koren
- Heart Institute, Emek Medical Center, Afula, Israel.,Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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2
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Hammad B, Saleh Y, Almaghraby A, Abdel-Hay MA. Eustachian valve infective endocarditis. BMJ Case Rep 2019; 12:12/4/e228653. [PMID: 30975780 DOI: 10.1136/bcr-2018-228653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
A 40-year-old woman presented with postoperative fever. Echocardiography revealed a large pedunculated cauliflower right atrial mass of heterogeneous echogenicity attached to the eustachian valve measuring about 2×3 cm. She underwent surgical excision, gross and microscopical examination were consistent with eustachian valve infective endocarditis.
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Affiliation(s)
- Basma Hammad
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Yehia Saleh
- Faculty of Medicine, Alexandria University, Alexandria, Egypt.,Michigan State University, East Lansing, Michigan, USA
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3
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Chan Pei Loon J, Chao C, Younger JF, Lo A, Dahiya A, Atherton JJ, Jalali H, Prasad SB. Eustachian valve endocarditis: Case report and literature review. Australas J Ultrasound Med 2017; 21:29-35. [DOI: 10.1002/ajum.12078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Julian Chan Pei Loon
- Department of Cardiology; Royal Brisbane and Women's Hospital; Herston Road Brisbane Queensland Australia
| | - Charles Chao
- Department of Cardiology; Royal Brisbane and Women's Hospital; Herston Road Brisbane Queensland Australia
| | - John F. Younger
- Department of Cardiology; Royal Brisbane and Women's Hospital; Herston Road Brisbane Queensland Australia
| | - Ada Lo
- Department of Cardiology; Royal Brisbane and Women's Hospital; Herston Road Brisbane Queensland Australia
| | - Arun Dahiya
- Department of Cardiology; Royal Brisbane and Women's Hospital; Herston Road Brisbane Queensland Australia
| | - John J. Atherton
- Department of Cardiology; Royal Brisbane and Women's Hospital; Herston Road Brisbane Queensland Australia
| | | | - Sandhir B. Prasad
- Department of Cardiology; Royal Brisbane and Women's Hospital and Mater Adult Hospital; Herston Road Brisbane Queensland Australia
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4
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Kottam A, Kaur R, Bhandare D, Zmily H, Bheemreddy S, Brar H, Herawi M, Afonso L. Actinomycotic endocarditis of the eustachian valve: a rare case and a review of the literature. Tex Heart Inst J 2015; 42:44-9. [PMID: 25873798 PMCID: PMC4378043 DOI: 10.14503/thij-13-3517] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Eustachian valve endocarditis caused by Actinomyces species is extremely rare. A literature review revealed only one reported case-caused by Actinomyces israelii in an intravenous drug abuser. Our patient, a 30-year-old woman who at first appeared to be in good health, presented with fever, a large mobile mass on the eustachian valve, and extensive intra-abdominal and pelvic masses that looked malignant. Histopathologic examination of tissue found in association with an intrauterine contraceptive device revealed filamentous, branching microorganisms consistent with Actinomyces turicensis. This patient was treated successfully with antibiotic agents. In addition to presenting a new case of a rare condition, we discuss cardiac actinomycotic infections in general and eustachian valve endocarditis in particular: its predisposing factors, clinical course, sequelae, and our approaches to its management.
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Affiliation(s)
- Anupama Kottam
- Address for reprints: Anupama Kottam, MD, Division of Cardiology, 4 Hudson, Harper University Hospital, Wayne State University, 3990 John R St., Detroit, MI 48201, E-mail:
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5
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Abstract
Eustachian valve endocarditis (EVE) is a distinctly rare and underdiagnosed entity. We report 2 new cases caused by vancomycin resistant Staphylococcus aureus and Staphylococcus hominis diagnosed on transesophageal echocardiography (TEE). Although, 63% of Eustachian valve endocarditis is caused by Staphylococcus aureus, we report the first case of vancomycin resistant Staphylococcus aureus and first case related to implantable venous access systems. EVE is now seen more commonly in elderly population with diverse microbial cultures and antibiotic sensitivities. TTE is the first modality for investigation of EVE, however a negative TTE does not preclude the diagnosis, as only 88% of cases were diagnosed on TEE.
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Affiliation(s)
- Gaurav Alreja
- Department of Medicine, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA, USA
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7
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Sánchez Andrés A, Carrasco Moreno JI. Redundant eustachian valve endocarditis: neonatal diagnosis. Rev Esp Cardiol 2009; 62:1200-1202. [PMID: 19793532 DOI: 10.1016/s1885-5857(09)73341-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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8
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Asirdizer M, Tatlisumak E. The role of eustachian valve and patent foramen ovale in sudden death. ACTA ACUST UNITED AC 2006; 13:262-7. [PMID: 16442333 DOI: 10.1016/j.jcfm.2005.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2005] [Revised: 11/11/2005] [Accepted: 11/20/2005] [Indexed: 10/25/2022]
Abstract
Sudden unexpected cardiac death is the leading cause of death in industrialized countries. Patent foramen ovale and eustachian valve are two of cardiac diseases and they may be associated with clinical disorders as embolism, stroke, plathypnea-orthodeoxia syndrome, carcinoid heart disease, atrial flutter and endocarditis. The literature for the roles of patent foramen ovale and eustachian valve in the causes of sudden deaths are reviewed.
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Affiliation(s)
- Mahmut Asirdizer
- Department of Forensic Medicine, Medical Faculty of Celal Bayar University, 45030 Manisa, Turkey.
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Wong RCC, Teo SG, Yeo TC. An unusual right-sided endocarditis: A case report of eustachian valve endocarditis. Int J Cardiol 2006; 109:406-7. [PMID: 15993961 DOI: 10.1016/j.ijcard.2005.05.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2005] [Accepted: 05/14/2005] [Indexed: 10/25/2022]
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Pellicelli AM, Pino P, Terranova A, D'Ambrosio C, Soccorsi F. Eustachian valve endocarditis: a rare localization of right side endocarditis. A case report and review of the literature. Cardiovasc Ultrasound 2005; 3:30. [PMID: 16171516 PMCID: PMC1236943 DOI: 10.1186/1476-7120-3-30] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2005] [Accepted: 09/19/2005] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Right-sided endocarditis occurs predominantly in intravenous drug users, in patients with pacemaker or central venous lines and in patients with congenital heart disease. The vast majority of cases involve the tricuspid valve. Eustachian valve endocarditis is an uncommon disease with similar signs and symptoms of the tricuspid valve endocarditis. A series of only 16 cases of eustachian valve endocarditis are reported in the literature. CASE PRESENTATION We present a case of a 25-year old woman with intravenous drug abuse who had a staphylococcus aureus tricuspid valve endocarditis associated to eustachian valve endocarditis. Transthoracic echocardiography, as first line examination, showed the vegetations on tricuspid and eustachian valve. CONCLUSION Our case describe an unusual location of right side endocarditis in a intravenous drug abuser. In our case, in accord with other cases described in the literature, transthoracic echocardiography disclosed eustachian valve endocarditis. Antimicrobial management is not altered by the recognition of eustachian valve endocarditis. Antibiotic treatment and duration of eustachian endocarditis depends on the isolated organism and is similar to antibiotic therapy used in native valve endocarditis.
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Affiliation(s)
- Adriano M Pellicelli
- Consultant of Infectious disease, San Camillo Forlanini Hospital, via Portuense 332 00149 Rome Italy
- Department of Internal Medicine San Camillo Forlanini Hospital via Portuense 332 00149 Rome Italy
| | - Paolo Pino
- Department of Cardiovascular Science San Camillo Forlanini Hospital via Portuense 332 00149 Rome Italy
| | - Antonio Terranova
- Department of Cardiovascular Science San Camillo Forlanini Hospital via Portuense 332 00149 Rome Italy
| | - Cecilia D'Ambrosio
- Department of Internal Medicine San Camillo Forlanini Hospital via Portuense 332 00149 Rome Italy
| | - Fabrizio Soccorsi
- Department of Internal Medicine San Camillo Forlanini Hospital via Portuense 332 00149 Rome Italy
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11
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Schuchlenz HW, Saurer G, Weihs W, Rehak P. Persisting eustachian valve in adults: relation to patent foramen ovale and cerebrovascular events. J Am Soc Echocardiogr 2004; 17:231-3. [PMID: 14981420 DOI: 10.1016/j.echo.2003.12.003] [Citation(s) in RCA: 137] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The eustachian valve (EV) (valvula venae cavae inferioris) is a remnant of the embryonic right valve of the sinus venosus. Embryologically, the EV directs oxygenated blood from the inferior vena cava across the patent foramen ovale (PFO) into the systemic circulation. Transthoracic echocardiography shows the EV in the majority of newborns, but the prevalence of EV in adults studied with transesophageal echocardiography is unknown. We studied whether the presence of an EV is associated with PFO or with cryptogenic stroke. METHODS The frequency and size of the EV was studied in 211 consecutive patients undergoing transesophageal echocardiography after a cryptogenic stroke and in 95 consecutive patients without cerebrovascular events. In all 306 patients, the presence of a PFO was studied with 2-dimensional transesophageal echocardiographic, color Doppler, and contrast echocardiographic studies. RESULTS An EV was seen in 174 of 306 patients overall (57%). The mean size was 1.0 +/- 0.4 cm (range: 0.5-2.0); 70% of patients with an EV had a PFO (Cohen's kappa = 0.75; P <.001). This relationship was not significantly influenced by a cryptogenic stroke. The prevalence of PFO was 30% in the control group and 61% for those with presumed paradoxical embolism (P <.001). Thus, an EV was more common for patients with presumed paradoxical embolism than in control patients (143 of 211 68% vs 31 of 95 33%, respectively, P <.001). There was no significant difference in the size of the EV between the 2 groups (1.1 vs 1.0 cm; P =.24). CONCLUSION A persisting EV is a frequent finding in patients with a PFO. By directing the blood from the inferior cava to the interatrial septum, a persisting EV may prevent spontaneous closure of PFO after birth and may, therefore, indirectly predispose to paradoxical embolism.
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Affiliation(s)
- Herwig W Schuchlenz
- Department of Medicine II, LKH Graz-West, Göstingerstrasse 22, A-8020 Graz, Austria.
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12
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Abstract
Staphylococcus aureus is a leading cause of bacteremia and endocarditis. Over the past several years, the frequency of S aureus bacteremia (SAB) has increased dramatically. This increasing frequency, coupled with increasing rates of antibiotic resistance, has renewed interest in this serious, common infection. S aureus is a unique pathogen because of its virulent properties, its protean manifestations, and its ability to cause endocarditis on architecturally normal cardiac valves. Although the possibility of underlying endocarditis arises in virtually every patient with SAB, only a minority of bacteremic patients will actually have cardiac involvement. Distinguishing patients with S aureus infective endocarditis (IE) from those with uncomplicated SAB is essential, but often difficult. In this review, the authors summarize recent changes in the epidemiology of SAB and IE, discuss the challenges in distinguishing SAB from IE, and discuss current trends in the management of patients with SAB and IE.
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Affiliation(s)
- Cathy A Petti
- Departments of Pathology and Medicine, Box 3879, Duke University Medical Center, Durham, NC 27710, USA
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Abstract
Although infective endocarditis is certainly not the most common infection seen in injecting drug users, it is the infection that clinicians most commonly think of when they consider infectious complications of injected drug use. The microbiology of infective endocarditis in injection drug users has remained relatively stable over the last several decades. Tricuspid valve endocarditis has been associated most frequently with injection drug use, but recent reports have suggested that involvement of left-sided valves is seen more often now than in the past. The use of transesophageal echocardiography has greatly advanced the ability to diagnose infective endocarditis and the cardiac complications of valvular infection.
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Affiliation(s)
- Patricia D Brown
- Division of Infectious Diseases, Wayne State University School of Medicine, 3990 John R, Detroit, MI 48201, USA.
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14
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Abstract
Staphylococcus aureus is a leading cause of bacteremia and endocarditis. Over the past several years, the frequency of S. aureus bacteremia (SAB) has increased dramatically. This increasing frequency, coupled with increasing rates of antibiotic resistance, has renewed interest in this serious, common infection. S. aureus is a unique pathogen because of its virulent properties, its protean manifestations, and its ability to cause endocarditis on architecturally normal cardiac valves. Although the possibility of underlying endocarditis arises in virtually every patient with SAB, only a minority of bacteremic patients will actually have cardiac involvement. Distinguishing patients with S. aureus infective endocarditis (IE) from those with uncomplicated SAB is essential, but often difficult. In this review, the authors summarize recent changes in the epidemiology of SAB and IE, discuss the challenges in distinguishing SAB from IE, and discuss current trends in the management of patients with SAB and IE.
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Affiliation(s)
- Cathy A Petti
- Departments of Pathology and Medicine, Box 3879, Duke University Medical Center, Durham, NC 27710, USA
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San Román JA, Vilacosta I, Sarriá C, Garcimartín I, Rollán MJ, Fernández-Avilés F. Eustachian valve endocarditis: Is it worth searching for? Am Heart J 2001; 142:1037-40. [PMID: 11717609 DOI: 10.1067/mhj.2001.119125] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Only a few cases of eustachian valve endocarditis have been reported. Whether the eustachian valve is an uncommon site for a vegetation to be attached or whether the disease is missed because a systematic approach to this valve is not routinely performed in the search for vegetations is not known. METHODS Every patient suspected of having endocarditis undergoes a specific approach, which includes a systematic study of the eustachian valve. In 10 patients with large valves but without signs and symptoms of endocarditis, we identified 2 specific findings: width <3 mm and a regular oscillating movement. A blinded evaluation in the 10 control subjects and 30 patients with right-sided endocarditis, including the 5 with eustachian valve endocarditis, showed an agreement of 97% (39/40). RESULTS Five of 152 patients with right-sided endocarditis were found to have eustachian valve vegetations (3.3%). Patients were young (age range 22-34 years) and all had predisposing factors (3 intravenous drug abusers, 2 central venous lines), fever, and septic pulmonary embolism. Staphylococcus aureus was cultured in all cases. Tricuspid involvement was found in 4 patients, and only 1 patient had isolated eustachian valve endocarditis. All patients did well with culture-guided antibiotics. CONCLUSIONS Our results suggest that eustachian valve endocarditis may be more frequent than is believed. Thus a systematic interrogation of the eustachian valve should be included in the echocardiographic examination of a patient suspected of having endocarditis.
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Affiliation(s)
- J A San Román
- Institute of Heart Sciences (ICICOR), Hospital Universitario, Valladolid, Spain.
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Sawhney N, Palakodeti V, Raisinghani A, Rickman LS, DeMaria AN, Blanchard DG. Eustachian valve endocarditis: a case series and analysis of the literature. J Am Soc Echocardiogr 2001; 14:1139-42. [PMID: 11696843 DOI: 10.1067/mje.2001.114012] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Eustachian valve endocarditis (EVE) is a syndrome characterized by clinical signs and symptoms of right-sided infective endocarditis in association with an infective vegetation on the eustachian valve. EVE usually occurs without associated involvement of any other cardiac valves, and it is difficult to diagnose accurately by transthoracic echocardiography. Transesophageal echocardiography appears to be a more sensitive tool for the diagnosis of EVE, and it is recommended when a patient with typical signs of right-sided endocarditis has normal results on a transthoracic echocardiography study. In general, EVE responds well to conventional antibiotic therapy.
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Affiliation(s)
- N Sawhney
- Division of Cardiology, Department of Medicine, University of California-San Diego, School of Medicine and UCSD Medical Center, 200 W. Arbor Street #8411, San Diego, CA 92103-8411, USA
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Abstract
A 76-year-old man was admitted for ethanol detoxification. He was found to be in atrial fibrillation with a rapid ventricular response that was refractory to electrical and chemical cardioversion attempts. The patient subsequently developed respiratory distress. A transesophageal echocardiogram revealed a vegetation attached to the eustachian valve and blood cultures grew Streptococcus viridans. After treatment with appropriate antibiotics, the patient converted to sinus rhythm with sotalol hydrochloride, and the eustachian valve vegetation resolved. This is the first reported case of eustachian valve endocarditis caused by S viridans.
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Affiliation(s)
- M A Schmidt
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor 48109-0644, USA
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Chamis AL, Gesty-Palmer D, Fowler VG, Corey GR. Echocardiography for the Diagnosis of Staphylococcus aureus Infective Endocarditis. Curr Infect Dis Rep 1999; 1:129-135. [PMID: 11095778 DOI: 10.1007/s11908-996-0019-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Staphylococcus aureus bacteremia (SAB) is a serious and growing problem. A longstanding controversy in infectious diseases has centered around the duration of therapy for patients with SAB. Fortunately, the refinement of echocardiography and the creation of new diagnostic criteria have aided in the diagnosis of infective endocarditis in patients with SAB. These advancements have resulted in the development of an algorithm that combines clinical, microbiologic, and echocardiographic findings to stratify patients with SAB into different treatment regimens.
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Affiliation(s)
- AL Chamis
- Department of Medicine and Division of Infectious Diseases, Duke University Medical Center, Box 3038, Durham, NC 27710, USA
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Punzo F, Guarini P, De Michele M, Accadia M, Irace L, Caruso A, Granato Corigliano G. Eustachian Valve Endocarditis in an Elderly Woman. Echocardiography 1999; 16:259-261. [PMID: 11175147 DOI: 10.1111/j.1540-8175.1999.tb00811.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We describe the transesophageal echocardiographic findings in Eustachian valve endocarditis for a 73-year-old woman with a previous history of mitral valve disease. After a 4-week treatment with antibiotics, follow-up echocardiographic examination showed a smaller vegetation.
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