Bacterial endocarditis in a patient with idiopathic hypertrophic subaortic stenosis

Clinical, Radiographic, and Microbiologic Features of Infective Endocarditis in Patients With Hypertrophic Cardiomyopathy

Infective endocarditis (IE) is an infection of the inner lining of the heart with high morbidity and mortality despite medical and surgical advancements in recent decades. Hypertrophic cardiomyopathy (HC) is one of several medical conditions that have been linked to an increased risk of IE, but there is a paucity of data on this association. We therefore sought to define the clinical phenotype of IE in patients with HC at a single tertiary care center. A retrospective cohort of 30 adult patients with HC diagnosed with IE between January 1, 2006 and December 31, 2016 at Mayo Clinic Rochester were identified. Similar rates of aortic (n = 14) and mitral (n = 16) valve involvement by IE were noted (47% vs 53%). This finding persisted even in patients with left-ventricular outflow tract obstruction and systolic anterior motion of the mitral valve. Symptomatic embolic complications occurred in 10 cases (33%). Surgical intervention was performed in 11 cases (37%). One-year mortality was remarkably low at 7%. In conclusion, in the largest single-center cohort of IE complicating HC, there were similar rates of both mitral and aortic valve involvement regardless of the presence of left ventricular outflow tract obstruction, which is contrary to a long-standing tenet regarding the association of HC and IE. Moreover, no "high risk" IE subset was identified based on HC-related parameters.

Infectious endocarditis in idiopathic hypertrophic subaortic stenosis: report of three cases and review of the literature

Three cases of infective endocarditis (IE) occurringg in patients with idiopathic hypertrophic subaortic stenosis (IHSS) are described. A review of the literature reveals the IE occurs in about 50 percent of the patients suffering from IHSS. It appears to complicate the natural history of the severe cases, at least as it appears from hemodynamic studies, being precipitated by the same factors and caused by the same infective organisms as in valvular heart disease. It has the same clinical picture and outcome, although the appearance of new murmurs was more common than in other types of heart disease complicated by IE, and indicated the same poor prognosis. The infection seems to involve both the aortic and the mitral valve, with equal frequency, and less commonly the ventricular outflow tract. The need for IE prophylaxis in cases of IHSS is stressed.

Mural vegetations at the site of endocardial trauma in infective endocarditis complicating idiopathic hypertrophic subaortic stenosis

In two patients infective endocarditis developed as the primary manifestation of idiopathic hypertrophic subaortic stenosis. Infected vegetations were present on the mitral and aortic valves. In addition, bacterial vegetations were observed on the septal endocardium at the site of contact between the mitral valve leaflet and the hypertrophic septum. Thus, chronic endocardial trauma, a common finding in idiopathic hypertrophic subaortic stenosis, may provide a fertile nidus for the development of bacterial vegetation.

Bacterial endocarditis in idiopathic hypertrophic subaortic stenosis

Bacterial endocarditis complicating idiopathic hypertrophic subaortic stenosis (IHSS) is uncommon but endocarditis may be the first clinical manifestation of IHSS. In this report of such a case, the aortic and the mitral valves were the sites of the bacterial infection. Many chordae tendineae to the mitral valve were ruptured from the extension of the infectious process. The endothelial lesions, which served as the seat for the bacterial infection on the anterior mitral leaflet, likely resulted from its abutting action against the septal prominence. Damage to the aortic valve leaflet may have resulted from abnormal valve motion caused by IHSS and created an environment conducive to endocarditis. This patient developed aortic insufficiency during the course of bacterial endocarditis, suggesting that the occasional association of aortic insufficiency in patients with IHSS may be secondary to healed endocarditis of the aortic valve.

Analysis of symptomatic course and prognosis and treatment of hypertrophic obstructive cardiomyopathy

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Management of pregnancy complicated by hypertrophic obstructive cardiomyopathy

We report our experiences with nine women suffering from hypertrophic obstructive cardiomyopathy who between them had 13 pregnancies, 10 of which were directly managed by us. Though at first we felt that the theoretical hazards of vaginal delivery indicated elective caesarean section, experience has convinced us that in the absence of an obstetrical contraindication these patients may be delivered vaginally provided a betaadrenergic blocking drug is administered during pregnancy and especially during labour, ergometrine is given at the end of the second stage, adequate supplies of cross-matched blood are available, and prophylaxis against infective endocarditis is administered. We have found no evidence of any adverse effects of either propranolol or pronethalol on the foetus.

Infective endocarditis in three patients with hypertrophic obstructive cardiomyopathy

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