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Saadia S, Sultan FAT, Iqbal S, Fatimi SH, Nasir A. Case report: Aorto-left atrial fistula-A rare complication of native aortic valve endocarditis. Egypt Heart J 2023; 75:58. [PMID: 37432517 DOI: 10.1186/s43044-023-00384-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/23/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Aorto-cavitary fistula is a rare complication of infective endocarditis. Multimodal imaging is commonly required to assess the severity and extent of infection because of the complex pathology of the valvular and paravalvular apparatus in endocarditis. CASE PRESENTATION We present an unusual case of a middle-aged man with recent history of meningoencephalitis who developed infective endocarditis complicated by ruptured abscess in inter-valvular fibrosa between aortic and mitral valve resulting in free communication or fistula formation between aorta and left atrium. Patient underwent double valve replacement (aortic and mitral) along with repair of the aorta. CONCLUSIONS Our case highlights recognition of this rare clinical presentation of aorto-left atrial fistula in infective endocarditis and the diagnostic role of transesophageal echocardiography in good clinical outcome with aggressive and timely management.
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Affiliation(s)
- Sheema Saadia
- Section of Cardiology, Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan
| | - Fateh Ali Tipoo Sultan
- Section of Cardiology, Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan.
| | - Sara Iqbal
- Section of Cardiothoracic Surgery, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
| | - Saulat Hasnain Fatimi
- Section of Cardiothoracic Surgery, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
| | - Aiysha Nasir
- Section of Cardiology, Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan
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2
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Contemporary Review of Multi-Modality Cardiac Imaging Evaluation of Infective Endocarditis. Life (Basel) 2023; 13:life13030639. [PMID: 36983795 PMCID: PMC10052933 DOI: 10.3390/life13030639] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/17/2023] [Accepted: 02/22/2023] [Indexed: 03/03/2023] Open
Abstract
Infective endocarditis (IE) remains to be a heterogeneous disease with high morbidity and mortality rates, which can affect native valves, prosthetic valves, and intra-cardiac devices, in addition to causing systemic complications. The combination of clinical, laboratory, and cardiac imaging evaluation is critical for early diagnosis and risk stratification of IE. This can facilitate timely medical and surgical management to improve patient outcomes. Key imaging findings for IE include vegetations, valve perforation, prosthetic valve dehiscence, pseudoaneurysms, abscesses, and fistulae. Transthoracic echocardiography continues to be the first-line imaging modality of choice, while transesophageal echocardiography subsequently provides an improved structural assessment and characterization of lesions to facilitate management decision in IE. Recent advances in other imaging modalities, especially cardiac computed tomography and 18F-fluorodeox-yglucose positron emission tomography, and to a lesser extent cardiac magnetic resonance imaging and other nuclear imaging techniques, have demonstrated important roles in providing complementary IE diagnostic and prognostic information. This review aims to discuss the individual and integrated utilities of contemporary multi-modality cardiac imaging for the assessment and treatment guidance of IE.
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Likaj E, Dumani S, Kuci S, Rruci E, Doko A, Refatllari A. Acquired Sub-aortic Gerbode Defect Following Tricuspid, Aortic, and Mitral Valve Endocarditis. Open Access Maced J Med Sci 2023. [DOI: 10.3889/oamjms.2023.10117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND: Communication between the left ventricle and right atrium, termed a Gerbode ventricular septal defect (VSD), was first described in 1838 and later explained with varying etiologies, including congenital and acquired forms. Most of the acquired LV-RA shunts are of either a postoperative or of infective etiology. Among these etiologies, infective endocarditis is a rare cause, and echocardiography is a mainstay of its diagnosis and clinical management.
CASE REPORT: Here, we describe the case of a patient with bacterial endocarditis as a cause of a left ventricle to right atrium shunt, with subsequent intraoperative diagnosis and surgical repair. A 38-year-old man with a history of fever in the past 2 weeks was diagnosed with bacterial endocarditis involving the tricuspid, aortic, and mitral valve. Pre-operative transesophageal echocardiography revealed a severe aortic regurgitation with large vegetations on the right and non-coronary cusps sizing about 1 cm2. The mitral valve had mild regurgitation and some filiform vegetations on the ventricular side of the anterior leaflet. The examination showed advanced tricuspid regurgitation with vegetations on the anterior and septal leaflets. The cardiologists also measured severe pulmonary hypertension up to 90 mmHg. During surgery, after careful observation, a communication between the left ventricle and the right atrium was discovered in the area under the junction between the right and non-coronary cusps of the aortic valve. The patient underwent aortic valve replacement with a 25-mm Regent mechanical valve (St. Jude Medical, St. Paul, MN), primary closure of a 5 mm ×5 mm septal defect using polyester 2.0 pledgeted sutures, replacement of the tricuspid valve with 31-mm Epic bio-prosthesis, and curettage of the ventricular side of the anterior mitral valve leaflet. The patient’s postoperative course was uneventful and he was transferred at the infective hospital on the 10th post-operative day. After 4 weeks of parenteral antibiotic therapy, the patient was discharged in good conditions.
CONCLUSION: To the best of our knowledge, this is a unique case reported with triple valve endocarditis and Gerbode defect treated with surgery. We encourage meticulous examination of patients with endocarditis to find abnormal communications.
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Ayad RD, Andraos AW, Taema KAE, Attia IM, Yehia M. Infective Endocarditis as a Cause of Critical Illness, In-hospital Mortality, and Complications. Indian J Crit Care Med 2022; 26:930-934. [PMID: 36042752 PMCID: PMC9363800 DOI: 10.5005/jp-journals-10071-24276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Critical illness due to infective endocarditis (IE) has high in-hospital mortality. Besides being a cause of sepsis, this disease has the potential nature to affect multiple organs. Patients and methods Data for 84 patients managed at the critical care medicine unit at Cairo University for 7 years were surveyed for IE using modified Dukes criteria. Among the patient group with a verified diagnosis of IE, patient characteristics (age and comorbidities), the grade of diagnosis, the blood culture result, echocardiographic findings, minor diagnostic signs (fever, presence of prosthetic valves and pacemaker, vascular phenomena, immunologic phenomena) and clinical complications (heart failure, septic shock, neurologic complications renal failure) were studied regarding their association to in-hospital mortality. Incidence of clinical complications was compared to the control group with sepsis due to other causes. Results The mortality rate in the IE group is 18.8%. Factors showing significant association to in-hospital mortality are; septic shock p = 0.01, neurological complications p = 0.025 (especially cerebral hemorrhage p = 0.025), indicated non-performed surgery p = 0.008, and presence of underlying heart failure with reduced ejection fraction (HFrEF), p = 0.002. Incidence of clinical complications showed no significant difference in IE patients and patients with other causes of sepsis except heart failure which showed significantly increased incidence in the IE group, p = 0.004. Conclusion Septic shock, neurological complications, indicated nonperformed surgery, and presence of underlying HFrEF are in-hospital mortality risk factors in critically ill patients due to IE. In-hospital mortality and clinical complication incidence (except heart failure) are similar to other causes of sepsis. How to cite this article Ayad RD, Andraos AW, Taema KAE, Attia IM, Yehia M. Infective Endocarditis as a Cause of Critical Illness, In-hospital Mortality, and Complications. Indian J Crit Care Med 2022;26(8):930-934.
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Affiliation(s)
- Roqia D Ayad
- Department of Critical Care Unit, Damietta Specialized Hospital, Damietta, Egypt
| | | | - Khaled AE Taema
- Department of Critical Care Medicine, Kasr Alainy, Cairo, Egypt
| | | | - Moamen Yehia
- Department of Critical Care Medicine, Kasr Alainy, Cairo, Egypt
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Bansal RC, Ali S, Prasad V, Razzouk A, Ghatnekar N, Floridia R. Extrinsic Circumflex Coronary Artery Compression and Occlusion by Mycotic Aneurysm of Left Aortic Sinus. CASE 2022; 6:158-164. [PMID: 35818485 PMCID: PMC9270671 DOI: 10.1016/j.case.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Mycotic aneurysm of the aortic sinus is a rare complication of aortic valve endocarditis. Mycotic aneurysm of left sinus causing LM compression and circumflex occlusion is shown. We present TTE and TEE approaches to making the diagnosis of this complex lesion. Sketches of complications of aortic valve endocarditis are presented.
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Panagides V, del Val D, Abdel-Wahab M, Mangner N, Durand E, Ihlemann N, Urena M, Pellegrini C, Giannini F, Scislo P, Huczek Z, Landt M, Auffret V, Sinning JM, Cheema AN, Nombela-Franco L, Chamandi C, Campelo-Parada F, Munoz-Garcia E, Herrmann HC, Testa L, Kim WK, Castillo JC, Alperi A, Tchetche D, Bartorelli AL, Kapadia S, Stortecky S, Amat-Santos I, Wijeysundera HC, Lisko J, Gutiérrez-Ibanes E, Serra V, Salido L, Alkhodair A, Livi U, Chakravarty T, Lerakis S, Vilalta V, Regueiro A, Romaguera R, Kappert U, Barbanti M, Masson JB, Maes F, Fiorina C, Miceli A, Kodali S, Ribeiro HB, Mangione JA, Brito FSD, Dato GMA, Rosato F, Ferreira MC, de Lima VC, Colafranceschi AS, Abizaid A, Marino MA, Esteves V, Andrea J, Godinho RR, Alfonso F, Eltchaninoff H, Søndergaard L, Himbert D, Husser O, Latib A, Breton HL, Servoz C, Pascual I, Siddiqui S, Olivares P, Hernandez-Antolin R, Webb JG, Sponga S, Makkar R, Kini AS, Boukhris M, Gervais P, Linke A, Crusius L, Holzhey D, Rodés-Cabau J. Mitral Valve Infective Endocarditis after Trans-Catheter Aortic Valve Implantation. Am J Cardiol 2022; 172:90-97. [PMID: 35387738 DOI: 10.1016/j.amjcard.2022.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/01/2022] [Accepted: 02/08/2022] [Indexed: 11/01/2022]
Abstract
Scarce data exist on mitral valve (MV) infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI). This multicenter study included a total of 579 patients with a diagnosis of definite IE after TAVI from the IE after TAVI International Registry and aimed to evaluate the incidence, characteristics, management, and outcomes of MV-IE after TAVI. A total of 86 patients (14.9%) had MV-IE. These patients were compared with 284 patients (49.1%) with involvement of the transcatheter heart valve (THV) only. Two factors were found to be associated with MV-IE: the use of self-expanding valves (adjusted odds ratio 2.49, 95% confidence interval [CI] 1.23 to 5.07, p = 0.012), and the presence of an aortic regurgitation ≥2 at discharge (adjusted odds ratio 3.33; 95% CI 1.43 to 7.73, p <0.01). There were no differences in IE timing and causative microorganisms between groups, but surgical management was significantly lower in patients with MV-IE (6.0%, vs 21.6% in patients with THV-IE, p = 0.001). All-cause mortality rates at 2-year follow-up were high and similar between patients with MV-IE (51.4%, 95% CI 39.8 to 64.1) and patients with THV-IE (51.5%, 95% CI 45.4 to 58.0) (log-rank p = 0.295). The factors independently associated with increased mortality risk in patients with MV-IE were the occurrence of heart failure (adjusted p <0.001) and septic shock (adjusted p <0.01) during the index hospitalization. One of 6 IE episodes after TAVI is localized on the MV. The implantation of a self-expanding THV and the presence of an aortic regurgitation ≥2 at discharge were associated with MV-IE. Patients with MV-IE were rarely operated on and had a poor prognosis at 2-year follow-up.
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7
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Khoury M, Khiella M, Sharma GK, Mir WAY, Kovacs D, Khosla S, Reddy VK, Monahan S, KC S, Shrestha DB. Rupture of Both Left-Sided Valves Following Endocarditis Causing One Trouble After Another: A Case Report. Cureus 2022; 14:e21189. [PMID: 35165632 PMCID: PMC8837907 DOI: 10.7759/cureus.21189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/12/2022] [Indexed: 12/05/2022] Open
Abstract
Despite the advances in managing left-sided infective endocarditis, complications are still not uncommon. Both aortic and mitral insufficiency can occur from infective endocarditis. In addition, valvular insufficiency due to rupture of valves presents acutely with cardiac decompensation and requires early surgical intervention. Here, we report a case of a 38-year-old intravenous drug user male with Group A Streptococcus-associated left-sided native valve infective endocarditis who presented with acute heart failure three months after his treatment of infective endocarditis. Infective endocarditis complications can lead to severe valve damage, causing acute heart failure, and may require immediate surgical intervention.
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Davierwala PM, Marin-Cuartas M, Misfeld M, Deo SV, Lehmann S, Garbade J, Holzhey DM, Borger MA, Bakhtiary F. Five-year outcomes following complex reconstructive surgery for infective endocarditis involving the intervalvular fibrous body. Eur J Cardiothorac Surg 2021; 58:1080-1087. [PMID: 32380545 DOI: 10.1093/ejcts/ezaa146] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Destruction of the intervalvular fibrous body (IFB) due to infective endocarditis (IE) warrants a complex operation involving radical debridement of all infected tissue, followed by double valve replacement (aortic and mitral valve replacement) with patch reconstruction of the IFB. This study assesses the 5-year outcomes in patients undergoing this complex procedure for treatment of double valve IE with IFB involvement. METHODS A total of 127 consecutive patients underwent double valve replacement with reconstruction of the IFB for active complex IE between January 1999 and December 2018. Primary outcomes were 3-year and 5-year survival, as well as 5-year freedom from reoperation. RESULTS Patients' mean age was 65.3 ± 12.9 years. Preoperative cardiogenic shock and sepsis were present in 17.3% and 18.9%, respectively. The majority of patients (81.3%) had undergone previous cardiac surgery. Overall, 30-day and 90-day mortality rates were 28.3% and 37.0%, respectively. The 3- and 5-year survival rates for all patients were 45.3 ± 5.1% and 41.8 ± 5.8%, and for those who survived the first 90 postoperative days 75.8 ± 6.1% and 70.0 ± 8.0%, respectively. The overall 5-year freedom from reoperation was 85.1 ± 5.7%. Preoperative predictors for 30-day mortality were Staphylococcus aureus [odds ratio (OR) 1.65; P = 0.04] and left ventricular ejection fraction (LVEF) <35% (OR 12.06; P = 0.03), for 90-day mortality acute kidney injury requiring dialysis (OR 6.2; P = 0.02) and LVEF <35% (OR 9.66; P = 0.03) and for long-term mortality cardiogenic shock (hazard ratio 2.46; P = 0.01). CONCLUSIONS Double valve replacement with reconstruction of the IFB in patients with complex IE is a challenging operation associated with high morbidity and mortality, particularly in the first 90 days after surgery. Survival and freedom from reoperation rates are acceptable thereafter, particularly considering the severity of disease and complex surgery.
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Affiliation(s)
- Piroze M Davierwala
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Mateo Marin-Cuartas
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Martin Misfeld
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Salil V Deo
- Department of Veterans Affairs, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Sven Lehmann
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Jens Garbade
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - David M Holzhey
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Michael A Borger
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Farhad Bakhtiary
- Department of Cardiothoracic Surgery, Helios Klinikum Siegburg, Siegburg, Germany
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 143:e72-e227. [PMID: 33332150 DOI: 10.1161/cir.0000000000000923] [Citation(s) in RCA: 531] [Impact Index Per Article: 177.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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10
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 143:e35-e71. [PMID: 33332149 DOI: 10.1161/cir.0000000000000932] [Citation(s) in RCA: 331] [Impact Index Per Article: 110.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIM This executive summary of the valvular heart disease guideline provides recommendations for clinicians to diagnose and manage valvular heart disease as well as supporting documentation to encourage their use. METHODS A comprehensive literature search was conducted from January 1, 2010, to March 1, 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, Cochrane, Agency for Healthcare Research and Quality Reports, and other selected database relevant to this guideline. Structure: Many recommendations from the earlier valvular heart disease guidelines have been updated with new evidence and provides newer options for diagnosis and treatment of valvular heart disease. This summary includes only the recommendations from the full guideline which focus on diagnostic work-up, the timing and choice of surgical and catheter interventions, and recommendations for medical therapy. The reader is referred to the full guideline for graphical flow charts, text, and tables with additional details about the rationale for and implementation of each recommendation, and the evidence tables detailing the data considered in developing these guidelines.
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11
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O’Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary. J Am Coll Cardiol 2021; 77:450-500. [DOI: 10.1016/j.jacc.2020.11.035] [Citation(s) in RCA: 272] [Impact Index Per Article: 90.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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12
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Raja J, Kumar R, Gourav KP. Kissing Lesion of Mitral Valve - A Case Report. Braz J Cardiovasc Surg 2021; 36:130-132. [PMID: 33594867 PMCID: PMC7918386 DOI: 10.21470/1678-9741-2019-0168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Aortic valve endocarditis can lead to secondary involvement of aorto-mitral curtain and the adjacent anterior mitral leaflet (AML). The secondary damage to AML is often caused by the infected jet of aortic regurgitation hitting the ventricular surface of the mitral leaflet, or by the pronounced bacterial vegetation that prolapses from the aortic valve into the left ventricular outflow tract. This is called ‘kissing lesion’. We describe a patient with infective endocarditis of the aortic valve causing perforation of both noncoronary cusp of aortic valve and the AML, which is rare.
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Affiliation(s)
- Javid Raja
- Department of Cardiothoracic and Vascular Surgery, Postgraduate Institute of Medical Education & Research - PGIMER, Chandigarh, India
| | - Rupesh Kumar
- Department of Cardiothoracic and Vascular Surgery, Postgraduate Institute of Medical Education & Research - PGIMER, Chandigarh, India
| | - Krishna Prasad Gourav
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education & Research - PGIMER, Chandigarh, India
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Saeedan MB, Wang TKM, Cremer P, Wahadat AR, Budde RPJ, Unai S, Pettersson GB, Bolen MA. Role of Cardiac CT in Infective Endocarditis: Current Evidence, Opportunities, and Challenges. Radiol Cardiothorac Imaging 2021; 3:e200378. [PMID: 33778655 PMCID: PMC7977690 DOI: 10.1148/ryct.2021200378] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/13/2020] [Accepted: 10/05/2020] [Indexed: 11/11/2022]
Abstract
Infective endocarditis (IE) can present with variable clinical and imaging findings and is associated with high morbidity and mortality. Substantial improvement of CT technology, most notably improved temporal and spatial resolution, has resulted in increased use of this modality in the evaluation of IE. The aim of this article is to review the potential role of cardiac CT in evaluating IE. Supplemental material is available for this article. © RSNA, 2021.
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Affiliation(s)
- Mnahi Bin Saeedan
- From the Section of Cardiovascular Imaging, Imaging Institute (M.B.S., T.K.M.W., P.C., M.A.B.), Section of Cardiovascular Imaging, Heart and Vascular Institute (T.K.M.W., P.C., M.A.B.), and Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute (S.U., G.B.P.), Cleveland Clinic, 9500 Euclid Ave, J1-4, Cleveland, OH 44915; Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands (A.R.W., R.P.J.B.); Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands (A.R.W.); and Department of Cardiology, Haga Hospital, The Hague, the Netherlands (A.R.W.)
| | - Tom Kai Ming Wang
- From the Section of Cardiovascular Imaging, Imaging Institute (M.B.S., T.K.M.W., P.C., M.A.B.), Section of Cardiovascular Imaging, Heart and Vascular Institute (T.K.M.W., P.C., M.A.B.), and Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute (S.U., G.B.P.), Cleveland Clinic, 9500 Euclid Ave, J1-4, Cleveland, OH 44915; Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands (A.R.W., R.P.J.B.); Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands (A.R.W.); and Department of Cardiology, Haga Hospital, The Hague, the Netherlands (A.R.W.)
| | - Paul Cremer
- From the Section of Cardiovascular Imaging, Imaging Institute (M.B.S., T.K.M.W., P.C., M.A.B.), Section of Cardiovascular Imaging, Heart and Vascular Institute (T.K.M.W., P.C., M.A.B.), and Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute (S.U., G.B.P.), Cleveland Clinic, 9500 Euclid Ave, J1-4, Cleveland, OH 44915; Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands (A.R.W., R.P.J.B.); Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands (A.R.W.); and Department of Cardiology, Haga Hospital, The Hague, the Netherlands (A.R.W.)
| | - Ali R. Wahadat
- From the Section of Cardiovascular Imaging, Imaging Institute (M.B.S., T.K.M.W., P.C., M.A.B.), Section of Cardiovascular Imaging, Heart and Vascular Institute (T.K.M.W., P.C., M.A.B.), and Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute (S.U., G.B.P.), Cleveland Clinic, 9500 Euclid Ave, J1-4, Cleveland, OH 44915; Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands (A.R.W., R.P.J.B.); Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands (A.R.W.); and Department of Cardiology, Haga Hospital, The Hague, the Netherlands (A.R.W.)
| | - Ricardo P. J. Budde
- From the Section of Cardiovascular Imaging, Imaging Institute (M.B.S., T.K.M.W., P.C., M.A.B.), Section of Cardiovascular Imaging, Heart and Vascular Institute (T.K.M.W., P.C., M.A.B.), and Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute (S.U., G.B.P.), Cleveland Clinic, 9500 Euclid Ave, J1-4, Cleveland, OH 44915; Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands (A.R.W., R.P.J.B.); Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands (A.R.W.); and Department of Cardiology, Haga Hospital, The Hague, the Netherlands (A.R.W.)
| | - Shinya Unai
- From the Section of Cardiovascular Imaging, Imaging Institute (M.B.S., T.K.M.W., P.C., M.A.B.), Section of Cardiovascular Imaging, Heart and Vascular Institute (T.K.M.W., P.C., M.A.B.), and Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute (S.U., G.B.P.), Cleveland Clinic, 9500 Euclid Ave, J1-4, Cleveland, OH 44915; Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands (A.R.W., R.P.J.B.); Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands (A.R.W.); and Department of Cardiology, Haga Hospital, The Hague, the Netherlands (A.R.W.)
| | - Gosta B. Pettersson
- From the Section of Cardiovascular Imaging, Imaging Institute (M.B.S., T.K.M.W., P.C., M.A.B.), Section of Cardiovascular Imaging, Heart and Vascular Institute (T.K.M.W., P.C., M.A.B.), and Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute (S.U., G.B.P.), Cleveland Clinic, 9500 Euclid Ave, J1-4, Cleveland, OH 44915; Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands (A.R.W., R.P.J.B.); Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands (A.R.W.); and Department of Cardiology, Haga Hospital, The Hague, the Netherlands (A.R.W.)
| | - Michael A. Bolen
- From the Section of Cardiovascular Imaging, Imaging Institute (M.B.S., T.K.M.W., P.C., M.A.B.), Section of Cardiovascular Imaging, Heart and Vascular Institute (T.K.M.W., P.C., M.A.B.), and Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute (S.U., G.B.P.), Cleveland Clinic, 9500 Euclid Ave, J1-4, Cleveland, OH 44915; Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands (A.R.W., R.P.J.B.); Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands (A.R.W.); and Department of Cardiology, Haga Hospital, The Hague, the Netherlands (A.R.W.)
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14
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Iacona GM, Roselli EE. Patch Repair of Aortic Mitral Continuity Pseudoaneurysm Through Transverse Sinus. Ann Thorac Surg 2020; 111:e309. [PMID: 33373591 DOI: 10.1016/j.athoracsur.2020.09.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/22/2020] [Accepted: 09/26/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Gabriele M Iacona
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eric E Roselli
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
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15
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Mihos CG, Nappi F. A narrative review of echocardiography in infective endocarditis of the right heart. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1622. [PMID: 33437821 PMCID: PMC7791248 DOI: 10.21037/atm-20-5198] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Infective endocarditis (IE) is characterized by bacterial or fungal masses that form in the cardiac chambers and valves, and in severe cases invade the endocardium or intra-cardiac vessels. Right-sided IE accounts for 5% to 10% of cases, with a low mortality cited at 6%. A history of intravenous drug abuse (IVDU) is present in 90% of isolated right-sided IE cases, with normal intra-cardiac anatomy prior to infection in approximately 80%. Nevertheless, up to 50% of patients require early surgical intervention which is associated with significant peri-operative morbidity. Echocardiography is the gold standard for diagnosis with a sensitivity of 80% for the transthoracic modality and 95% for transesophageal studies; it provides important clinical information regarding the severity of infection and development of secondary complications. This includes identification of active infective vegetations, healed IE, prosthetic valve IE, and abscess formation and rupture. Prompt clinical, microbiologic, and imaging assessment of patients with suspected left or right-sided IE is of paramount importance and is reflected in the modified Duke criteria, the well-validated algorithm for accurate and timely diagnosis of IE. Data suggests the criteria sensitivity may be decreased in right-sided IE only, and thus, care must be taken to perform skilled and detailed echocardiographic assessments of the right heart in suspected cases. Herein we provide a review of IE of the right heart, with a focus on pathophysiology and its echocardiographic presentation and characteristics.
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Affiliation(s)
- Christos G Mihos
- Echocardiography Laboratory, Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France
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16
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Intra-operative trans-esophageal echocardiography in heart valve disease. Indian J Thorac Cardiovasc Surg 2020; 36:140-153. [PMID: 33061195 DOI: 10.1007/s12055-019-00909-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 11/11/2019] [Accepted: 11/18/2019] [Indexed: 01/26/2023] Open
Abstract
Peri-operative echocardiography is widely used because it provides information that significantly influences clinical/surgical management and improves outcome in patients undergoing cardiac surgery. The role of intra-operative trans-esophageal echocardiography (TEE) in valvular heart disease cannot be emphasized enough. Increasing use of newer surgical techniques-valve repairs and minimal invasive cardiac surgery also warrants intra-operative TEE. It gives us better insight into the anatomy and physiology of the valvular lesion by digital imaging. This manuscript provides an illustrative case based overview of intra operative TEE (IOTEE) in heart valve surgery.
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17
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Paul A, Chacko ST, George PV. Cryptic cavity with an unusual drainage. BRITISH HEART JOURNAL 2019; 105:1499-1524. [DOI: 10.1136/heartjnl-2019-315141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/11/2019] [Accepted: 05/14/2019] [Indexed: 11/04/2022]
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18
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Dogra V, Satyarthi S, Jain A, Nigam A, Ali A, Geelani MA. Aortomitral intervalvular fibrosa aneurysm-a rare case. Indian J Thorac Cardiovasc Surg 2019; 36:64-66. [PMID: 33061097 DOI: 10.1007/s12055-019-00858-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/16/2019] [Accepted: 07/18/2019] [Indexed: 11/27/2022] Open
Abstract
Aortomitral intervalvular fibrosa aneurysm is a rare entity but a life-threatening condition. We present a case of young male presented with NYHA functional class IV dyspnea where aneurysm ruptured into the left atrium.
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Affiliation(s)
- Vipul Dogra
- Department of CTVS, G B Pant Institute of Postgraduate Medical Education and Research, New Delhi, 110002 India
| | - Subodh Satyarthi
- Department of CTVS, G B Pant Institute of Postgraduate Medical Education and Research, New Delhi, 110002 India
| | - Ankit Jain
- Department of CTVS, G B Pant Institute of Postgraduate Medical Education and Research, New Delhi, 110002 India
| | - Arima Nigam
- Department of Cardiology, G B Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Ahmed Ali
- Department of CTVS, G B Pant Institute of Postgraduate Medical Education and Research, New Delhi, 110002 India
| | - Muhammed Abid Geelani
- Department of CTVS, G B Pant Institute of Postgraduate Medical Education and Research, New Delhi, 110002 India
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19
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Wang H, Zheng Z, Yao L, Mou Y, Wang X. Giant left ventricular pseudoaneurysm: a rare acute complication of radiofrequency catheter ablation for premature ventricular contraction. J Cardiothorac Surg 2019; 14:131. [PMID: 31272454 PMCID: PMC6610948 DOI: 10.1186/s13019-019-0946-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 06/20/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Radiofrequency catheter ablation is approved effective therapy for premature ventricular contraction. However, the rare but serious complication such as pseudoaneurysm should be given more attention. It is life-threatening due to the high risk of rupture. Only few cases have been reported in the literature. We herein report a huge acute left ventricular pseudoaneurysm after catheter ablation therapy. CASE PRESENTATION A 69-year-old man underwent radiofrequency catheter ablation for premature ventricular contraction at a local hospital. The patient developed shock the second day after ablation. A chest computed tomography (CT) scan showed pericardial effusion. Pericardiocentesis was performed, and the puncture fluid was a bloody pericardial effusion. The transthoracic echocardiogram revealed an 9- × 4-cm giant pseudoaneurysm with a cystic structure in the left ventricular inferior wall near the mitral annulus along the left atrium. The pseudoaneurysm was connected to the left ventricular cavity through a 8-mm neck, and the lumen was filled with systolic and diastolic blood flow. The patient underwent three-dimensional transesophageal echocardiography. The pseudoaneurysm and the tract was clearly visible. Emergency surgery was performed to resect the pseudoaneurysm. A bovine pericardial patch was placed on the neck of the pseudoaneurysm. Echocardiographic examination confirmed the absence of cardiac lesions after the operation. CONCLUSIONS It is rare to see such a large pseudoaneurysm after radiofrequency catheter ablation. Clinicians should be allert to the potential risks to patients in the process of an effective treatment. Echocardiography plays an important role in the prompt diagnosis and prognosis of this disease. Emergency surgery is a better method for treatment of huge pseudoaneurysm.
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Affiliation(s)
- Hongxia Wang
- Echocardiography and Vascular Ultrasound Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Zhelan Zheng
- Echocardiography and Vascular Ultrasound Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Lei Yao
- Echocardiography and Vascular Ultrasound Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yun Mou
- Echocardiography and Vascular Ultrasound Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Xiuqin Wang
- Echocardiography and Vascular Ultrasound Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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20
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Cresti A, Baratta P, De Sensi F, Solari M, Sposato B, Minelli S, Cioffi N, Franci L, Scalese M, Limbruno U. Normal Values of the Mitral-Aortic Intervalvular Fibrosa Thickness: A Multimodality Study. J Cardiovasc Echogr 2019; 29:95-102. [PMID: 31728299 PMCID: PMC6829758 DOI: 10.4103/jcecho.jcecho_28_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: The avascular region of the fibrous body between the mitral and aortic valves, named mitral-aortic intervalvular fibrosa (MAIVF), is often involved in the periaortic diffusion of infective endocarditis (IE), resulting in abscess or pseudoaneurysm formation. The early recognition of these life-threatening complications is of crucial importance, as urgent surgical correction is necessary. In the first stages of the abscess formation, the only sign is an increased thickness of the MAIVF. To the best of our knowledge, normal transesophageal echocardiography (TEE) examination reference values for MAIVF thickness has not yet been established. The aim of the study was to define the normal ranges of MAIVF thickness in a population of healthy adults who underwent a TEE examination. Materials and Methods: A population of consecutive adult patients who underwent a TEE examination was enrolled in the study. Measurement was performed in short-axis (SAX) and long-axis (LAX) views. Mean-2 standard deviations (mean-2SDs) and 5%, 10%, 90%, and 95% confidence intervals were evaluated. A comparison with MAIVF thickness in patients affected by aortic IE complicated by abscess formation was performed, and receiver operating characteristic (ROC) curves were constructed to achieve the optimal cutoff value of normality. Results: A total of 477 consecutive Caucasian adult patients were enrolled (mean age: 69 years, range: 27–93 years). Mean-2SD MAIVF measurement in SAX view was 0.325 cm (95% confidence interval [CI]: 0.319–0.330 cm) and in LAX view was 0.340 cm (95% CI: 0.334–0.346 cm). Computed tomography–MAIVF mean measurement (±2SD) was 0.237 cm (95% CI: 0.110–0.340 cm). ROC curves showed that a cutoff SAX value measurement of 0.552 (area under the curve [AUC]: 95.2%) had a sensibility of 88.2% and a specificity of 92.4%; a LAX measurement value of 0.623 (AUC: 93.3%) had a sensibility of 82.7% and a specificity of 85.7%. The multivariate analysis showed no significant correlation between MAIVF thickness, age, and sex. Conclusion: In healthy patients, MAIVF thickness should not exceed 0.600 cm. Above these values, the suspicion of a periaortic abscess formation should be raised. MAIVF increased thickness may be an early sign of perivalvular diffusion requiring an urgent endocarditis team evaluation.
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Affiliation(s)
- Alberto Cresti
- Cardio-Neurovascular Department, Misricordia Hospital, Grosseto, Italy
| | - Pasquale Baratta
- Cardio-Neurovascular Department, Misricordia Hospital, Grosseto, Italy
| | | | - Marco Solari
- Cardio-Neurovascular Department, Misricordia Hospital, Grosseto, Italy
| | - Bruno Sposato
- Pneumology Department, Azienda USL Toscana Sudest, Misericordia Hospital, Grosseto, Italy.,Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Stefano Minelli
- Pneumology Department, Azienda USL Toscana Sudest, Misericordia Hospital, Grosseto, Italy
| | - Nevada Cioffi
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Luca Franci
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - M Scalese
- Department of Epidemiology and Health Research, Institute of Clinical Physiology, National Council of Research, F. G. Monasterio, Pisa, Italy
| | - Ugo Limbruno
- Cardio-Neurovascular Department, Misricordia Hospital, Grosseto, Italy
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21
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Saksena D, Mishra YK, Muralidharan S, Kanhere V, Srivastava P, Srivastava CP. Follow-up and management of valvular heart disease patients with prosthetic valve: a clinical practice guideline for Indian scenario. Indian J Thorac Cardiovasc Surg 2019; 35:3-44. [PMID: 33061064 PMCID: PMC7525528 DOI: 10.1007/s12055-019-00789-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Valvular heart disease (VHD) patients after prosthetic valve implantation are at risk of thromboembolic events. Follow-up care of patients with prosthetic valve has a paramount role in reducing the morbidity and mortality. Currently, in India, there is quintessential need to stream line the follow-up care of prosthetic valve patients. This mandates the development of a consensus guideline for the antithrombotic therapy in VHD patients post prosthetic valve implantation. METHODS A national level panel was constituted comprising 13 leading cardio care experts in India who thoroughly reviewed the up to date literature, formulated the recommendations, and developed the consensus document. Later on, extensive discussions were held on this draft and the recommendations in 8 regional meetings involving 79 additional experts from the cardio care in India, to arrive at a consensus. The final consensus document is developed relying on the available evidence and/or majority consensus from all the meetings. RESULTS The panel recommended vitamin K antagonist (VKA) therapy with individualized target international normalized ratio (INR) in VHD patients after prosthetic valve implantation. The panel opined that management of prosthetic valve complications should be personalized on the basis of type of complications. In addition, the panel recommends to distinguish individuals with various co-morbidities and attend them appropriately. CONCLUSIONS Anticoagulant therapy with VKA seems to be an effective option post prosthetic valve implantation in VHD patients. However, the role for non-VKA oral therapy in prosthetic valve patients and the safety and efficacy of novel oral anticoagulants in patients with bioprosthetic valve need to be studied extensively.
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22
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Incidental Finding of Left Ventricular False Chamber: Diagnostic and Therapeutic Implications. Case Rep Med 2018; 2018:8478475. [PMID: 30073028 PMCID: PMC6057300 DOI: 10.1155/2018/8478475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 03/11/2018] [Accepted: 04/12/2018] [Indexed: 11/18/2022] Open
Abstract
We present the case of a 75-year-old man with incidental finding of a left ventricular false chamber at echocardiography. A multimodality imaging approach including also transesophageal echocardiography and cardiac magnetic resonance imaging allowed to better characterize the lesion and identify it as a pseudoaneurysm. Surgery showed an infective aetiology, which is rare, due to the finding of a large abscess in the cavity.
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23
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Koneru S, Huang SS, Oldan J, Betancor J, Popovic ZB, Rodriguez LL, Shrestha NK, Gordon S, Pettersson G, Bolen MA. Role of preoperative cardiac CT in the evaluation of infective endocarditis: comparison with transesophageal echocardiography and surgical findings. Cardiovasc Diagn Ther 2018; 8:439-449. [PMID: 30214859 DOI: 10.21037/cdt.2018.07.07] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Significant improvement of computed tomography (CT) technology in the last decade has led to more use of this modality for evaluating infective endocarditis (IE) especially since the introduction of high resolution electrocardiogram (ECG) synchronized multiphasic (4D) acquisition. While there are a number of reports on the accuracy and value of 4D CT for evaluation of IE, there is no published data regarding the performance of single-phase ECG gated CT for assessment of IE. The purpose of this study is to evaluate the sensitivity and specificity of preoperative single-phase ECG-gated CT imaging versus transesophageal echocardiography (TEE) in the assessment of complications related to IE, with comparison to surgical findings. Methods Among 899 patients with surgically proven IE in our database, 122 underwent contrast-enhanced ECG cardiac CT and were included in the study; 84 of these patients also underwent TEE. Results Overall, there was no significant difference between CT and TEE in the identification of pseudoaneurysm/abscess and dehiscence. For the detection of pseudoaneurysm/abscess in prosthetic valves, CT demonstrated higher sensitivity (81% vs. 64%) and specificity (75% vs. 33%) in patients with mechanical aortic valves; TEE demonstrated marginally higher sensitivity (72% vs. 63%) and specificity (80% vs. 73%) in patients with bioprosthetic aortic valves, although the differences are not statistically significant. TEE demonstrated significantly higher sensitivity (85% vs. 16%) in identifying vegetation in all patients (P<0.0001), including patients with prosthetic valves (sensitivity, 78% vs. 19%). The combined imaging findings of CT and TEE demonstrated improved sensitivity in identifying pseudoaneurysm/abscess and slightly improved detection of prosthesis dehiscence. Conclusions Preoperative single-phase gated CT can be seen as complementary to TEE in assessing complications of suspected IE or may be substituted for TEE when vegetation or dehiscence is depicted on transthoracic echocardiography and the patient has a contraindication to TEE.
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Affiliation(s)
- Srikanth Koneru
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA.,Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Steven S Huang
- Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, USA
| | - Jorge Oldan
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA.,Department of Radiology, University of North Carolina, Chapel Hill, USA
| | - Jorge Betancor
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Zoran B Popovic
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | | | - Nabin K Shrestha
- Department of Infectious Disease, Cleveland Clinic, Cleveland, USA
| | - Steven Gordon
- Department of Infectious Disease, Cleveland Clinic, Cleveland, USA
| | - Gosta Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, USA
| | - Michael A Bolen
- Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, USA
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24
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Kretzer A, Amhaz H, Nicoara A, Kendall M, Glower D, Jones MM. A Case of Gerbode Ventricular Septal Defect Endocarditis. ACTA ACUST UNITED AC 2018; 2:207-209. [PMID: 30370384 PMCID: PMC6200681 DOI: 10.1016/j.case.2018.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A Gerbode VSD is a communication between the left ventricle and right atrium. Etiologies include trauma, infective endocarditis, and iatrogenic causes. Echocardiographic evaluation for this defect requires a careful interrogation.
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Affiliation(s)
- Adam Kretzer
- Department of Anesthesiology, Northwestern University Medical Center, Chicago, Illinois
| | - Hassan Amhaz
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Alina Nicoara
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Mark Kendall
- Department of Anesthesiology, Rhode Island Hospital, Providence, Rhode Island
| | - Donald Glower
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Mandisa-Maia Jones
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
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25
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Low SCS, Attili A, Bach D, Agarwal PP. CT and MRI features of pseudoaneurysms of the mitral-aortic intervalvular fibrosa. Clin Imaging 2018; 47:74-79. [DOI: 10.1016/j.clinimag.2017.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 07/31/2017] [Accepted: 08/17/2017] [Indexed: 10/19/2022]
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26
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Apostolidou E, Beale C, Poppas A, Stockwell P. Pseudoaneurysm of the Mitral-Aortic Intervalvular Fibrosa: A Case Series with Literature Review. ACTA ACUST UNITED AC 2017; 1:221-226. [PMID: 30062286 PMCID: PMC6058760 DOI: 10.1016/j.case.2017.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
P-MAIVF is usually a complication of endocarditis or aortic valve surgery. It is promptly recognized on transesophageal echocardiography. It may cause symptoms and complications that warrant surgical intervention. Surgical intervention remains the recommended management for P-MAIVF.
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Affiliation(s)
- Eirini Apostolidou
- Section of Cardiology, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Charles Beale
- Section of Cardiology, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Athena Poppas
- Section of Cardiology, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Philip Stockwell
- Section of Cardiology, Brown University, Rhode Island Hospital, Providence, Rhode Island
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27
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Muscente F, Scarano M, Clemente D, Pezzuoli F, Parato VM. A Ruptured Mitral Valve Aneurysm as Complication of a Bicuspid Aortic Valve Endocarditis. J Cardiovasc Echogr 2017; 27:23-25. [PMID: 28465987 PMCID: PMC5353471 DOI: 10.4103/2211-4122.199063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
We present a case of a ruptured mitral valve (MV) aneurysm as a complication of a bicuspid aortic valve (BAV) endocarditis. It is about a young 35-year-old man, admitted to Cardiology Unit because of unexpected heart failure picture. We found a BAV endocarditis complicated by anterior MV-anterior leaflet aneurysm formation and subsequent severe MV regurgitation caused by aneurysm perforation. It was a particular and rare situation characterized by an infection of anterior mitral leaflet secondary to an infected regurgitant jet of a primary aortic infective endocarditis due to a BAV. A resulting aneurysm formation on the atrial side of the mitral anterior leaflet leads later to mitral perforation. In this article, we review the more relevant medical literature on this topic.
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Affiliation(s)
- Francesca Muscente
- Depatment of Emergency, Cardiology Unit, Madonna del Soccorso Hospital, San Benedetto del Tronto, Marche Region, Italy
| | - Michele Scarano
- Depatment of Emergency, Cardiology Unit, Madonna del Soccorso Hospital, San Benedetto del Tronto, Marche Region, Italy
| | - Daniela Clemente
- Depatment of Emergency, Cardiology Unit, Madonna del Soccorso Hospital, San Benedetto del Tronto, Marche Region, Italy
| | - Franco Pezzuoli
- Depatment of Emergency, Cardiology Unit, Madonna del Soccorso Hospital, San Benedetto del Tronto, Marche Region, Italy
| | - Vito Maurizio Parato
- Depatment of Emergency, Cardiology Unit, Madonna del Soccorso Hospital, San Benedetto del Tronto, Marche Region, Italy
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28
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Kumar P, Kenchappa K, Jena S, Manik G. Ruptured pseudo-aneurysm of the mitral–aortic intervalvular fibrosa — A 3D transesophageal echocardiographic depiction. J Cardiol Cases 2017; 15:161-162. [DOI: 10.1016/j.jccase.2016.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 12/18/2016] [Accepted: 12/30/2016] [Indexed: 10/20/2022] Open
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29
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Abstract
Mitral-aortic intervalvular fibrosa aneurysm is a rare disease with a few cases documented in children. We present the case of a 12-year-old boy, without a history of infection or previous surgery, diagnosed with MRI.
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30
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31
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Gil J, Antunes H, Marmelo B, Abreu L, Goncalves ML, Dos Santos LF, Cabral JC. Septic Shock of Unknown Origin: A Case Report of a Pseudoaneurysm of the Mitral-Aortic Intervalvular Fibrosa. J Clin Med Res 2017; 9:225-228. [PMID: 28179972 PMCID: PMC5289144 DOI: 10.14740/jocmr2903w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2017] [Indexed: 11/21/2022] Open
Abstract
Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (P-MAIVF) is a rare complication of infective endocarditis and trauma, particularly of aortic valve surgery. Clinical symptoms are usually unspecific and generally due to complications. Transesophageal echocardiography (TEE) is the most commonly used exam to diagnose P-MAIVF. The main echocardiographic feature is the presence of a cavity communicating with the left ventricular outflow tract that expands during systole and collapses during diastole. Most frequent complications are formation of a fistulous tract and compression of adjacent structures. Surgical correction is usually the treatment of choice. The authors describe a case of a female patient with a septic shock of unclear origin. After antibiotic therapy and organ-supporting measures without apparent improvements, a TEE revealed infective endocarditis, complicated with P-MAIVF. Despite adequate treatment, the patient did not survive for long enough to be submitted to surgical repair.
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Affiliation(s)
- Julio Gil
- Cardiology Department, Tondela-Viseu Hospital Centre, Viseu, Portugal
| | - Hugo Antunes
- Cardiology Department, Tondela-Viseu Hospital Centre, Viseu, Portugal
| | - Bruno Marmelo
- Cardiology Department, Tondela-Viseu Hospital Centre, Viseu, Portugal
| | - Luis Abreu
- Cardiology Department, Tondela-Viseu Hospital Centre, Viseu, Portugal
| | | | | | - Jose Costa Cabral
- Cardiology Department, Tondela-Viseu Hospital Centre, Viseu, Portugal
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32
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Sawai T, Nakahira J, Kitano M, Minami T. A postoperative left ventricular-right atrial shunt due to infectious endocarditis after aortic repair with aortic valve replacement detected by transesophageal echocardiography. JA Clin Rep 2016; 2:26. [PMID: 29497681 PMCID: PMC5818857 DOI: 10.1186/s40981-016-0052-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 09/23/2016] [Indexed: 12/05/2022] Open
Abstract
Infectious endocarditis (IE) with acute heart failure is a medical emergency. In particular, postoperative IE after aortic repair with an artificial vascular graft is a life-threatening matter. We present a case in which a mobile abscess appeared on the aortic valve annulus with an intra-cardiac shunt in the left ventricle (LV) to the right atrium (RA) after ascending aortic repair with aortic valve replacement (AVR) for acute type A aortic dissection. It was diagnosed with transesophageal echocardiography (TEE), which prompted further exploration.
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Mitral valve aneurysm: A serious complication of aortic valve endocarditis. Rev Port Cardiol 2016; 35:621.e1-621.e5. [DOI: 10.1016/j.repc.2016.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 02/06/2016] [Indexed: 11/18/2022] Open
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Sousa MJ, Alves V, Cabral S, Antunes N, Pereira LS, Oliveira F, Silveira J, Torres S. Mitral valve aneurysm: A serious complication of aortic valve endocarditis. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.repce.2016.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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35
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Agrawal Y, Konda M, Kalavakunta JK. Aorto-left atrial fistula: Rare cause of acute cardiac failure in a previously healthy individual. J Saudi Heart Assoc 2016; 28:270-3. [PMID: 27688677 PMCID: PMC5034481 DOI: 10.1016/j.jsha.2016.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Revised: 02/05/2016] [Accepted: 02/09/2016] [Indexed: 11/01/2022] Open
Abstract
Complications of valvular infective endocarditis involving the peri-annular region puts the patient at a significantly high risk of adverse outcomes including heart failure and death. The "mitral-aortic intervalvular fibrosa" is relatively avascular and offers little resistance to the spread of abscesses, aneurysm, and fistula formation. Aorto-cavitary fistulous tract formation in the setting of native valve infective endocarditis is associated with higher rates of heart failure, ventricular septal defect, and atrioventricular block than nonruptured abscesses. Thus, a high index of suspicion is needed for rapid and accurate diagnosis, which can guide further management. A transesophageal echocardiogram is the preferred modality of investigation in such cases. Staphylococci are reported to be the most common pathogen involved. In addition to early antibiotic therapy, prompt surgical intervention might save lives in these scenarios.
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Affiliation(s)
- Yashwant Agrawal
- Department of Internal Medicine/Pediatrics, Western Michigan University Homer Stryker School of Medicine, Kalamazoo, MI, aUSA
| | - Monoj Konda
- Department of Internal Medicine/Pediatrics, Western Michigan University Homer Stryker School of Medicine, Kalamazoo, MI, aUSA
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Abstract
Infective endocarditis is a life-threatening illness associated with significant morbidity and mortality. Previously a uniformly fatal disease, antibiotic therapy has reduced the mortality of native valve endocarditis to less than 20%. The incidence of infective endocarditis has not decreased, however, and 20,000 new cases are reported each year. Continued improvement in the prognosis of endocarditis is largely dependent on early and accurate diagnosis of the disease and its complications. Echocardiography has assumed an important role in the evaluation of infective endocarditis, both for the detection of vegetations and in the assessment of complications of the infectious process.
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Affiliation(s)
- Priscilla J. Peters
- Cooper University Hospital, Division of Cardiology, Echocardiography Laboratory, Camden, NJ,
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37
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Kinch LA, Bansal RC, de Lange MT. The Role of Echocardiography in Infective Endocarditis. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2016. [DOI: 10.1177/875647939200800503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Infective endocarditis continues to be a significant diagnostic and therapeutic problem. During the last two decades, transthoracic echocardiography, and more recently, transesophageal echocardiography have been used in patients with the clinical syndrome of endocarditis to detect vegetations and assess the extent of valvular damage. Certain echocardiographic findings have important prognostic implications and can help determine the timing of surgical intervention. This paper will review the role of echocardiography in the evaluation and management of patients with infective endocarditis.
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Affiliation(s)
- Loretta A. Kinch
- Echocardiography Laboratory and Diagnostic Medical Sonography Program, Loma Linda University Medical Center, Loma linda, California
| | - Ramesh C. Bansal
- Echocardiography Laboratory and Diagnostic Medical Sonography Program, Loma Linda University Medical Center, Loma linda, California; Section of Cardiology, Room 4420, Loma Linda University Medical Center Loma Linda, CA 92354
| | - Marie T. de Lange
- Echocardiography Laboratory and Diagnostic Medical Sonography Program, Loma Linda University Medical Center, Loma linda, California
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Wang CW, Yu CL, Pan HC, Chan SW, Wang KY, Lin WW. A Rare and Life-Threatening Complication of Infective Endocarditis: Pseudoaneurysm of the Mitral - Aortic Intervalvular Fibrosa. ACTA CARDIOLOGICA SINICA 2016; 31:358-60. [PMID: 27122893 DOI: 10.6515/acs20140928a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
UNLABELLED A 59 year-old previously healthy male was admitted to the hospital with fever reportedly several days in duration. His physical examination was unremarkable at first. Pneumonia was initially diagnosed, but acute pulmonary edema with a new grade III to and fro murmur developed 1 week later. Transesophageal echocardiography (TEE) disclosed a pseudoaneurysm of the mitral-aortic intervalvular fibrosa (P-MAIVF). Subsequent consultation with a cardiovascular surgeon resulted in a repaired aorta with otherwise uneventful results. P-MAIVF is a very rare complication of prosthetic aortic valve (AV) infective endocarditis, and even in native AV. Therefore a careful and through physical examination of patients and early TEE examination are essential in this rare complication of infective endocarditis. KEY WORDS Echocardiography; Infective endocarditis; Mitral-aortic intervalvular fibrosa; Pseudoaneurysm.
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Affiliation(s)
- Chi-Wei Wang
- Cardiovascular Center, Taichung Veterans General Hospital
| | - Chu-Leng Yu
- Cardiovascular Center, Taichung Veterans General Hospital
| | - Hung-Chih Pan
- Cardiovascular Center, Taichung Veterans General Hospital
| | - Si-Wa Chan
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Kuo-Yang Wang
- Cardiovascular Center, Taichung Veterans General Hospital; ; Department of Internal Medicine, Chung Shan Medical University Hospital; ; Department of Internal Medicine, China Medical University Hospital
| | - Wei-Wen Lin
- Cardiovascular Center, Taichung Veterans General Hospital; ; Department of Internal Medicine, China Medical University Hospital; ; Department of Life Science, Tunghai University
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39
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Han J, He Y, Gu X, Sun L, Zhao Y, Liu W, Zhang Y, Yang X, Li Y. Echocardiographic Diagnosis and Outcome of Pseudoaneurysm of the Mitral-Aortic Intervalvular Fibrosa: Results of a Single-Center Experience in Beijing. Medicine (Baltimore) 2016; 95:e3116. [PMID: 26986160 PMCID: PMC4839941 DOI: 10.1097/md.0000000000003116] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (P-MAIVF) is a rare but potentially fatal entity. Early diagnosis and surgical treatment are particularly important to decrease risk of mortality. The purpose of this study was to explore the echocardiographic characteristics and outcome of P-MAIVF and to evaluate the potential application of three-dimensional (3D) echocardiography in the evaluation of P-MAIVF. Clinical and echocardiographic characteristics were retrospectively evaluated in 9 patients with P-MAIVF, 5 of them assessed by 3D echocardiography. P-MAIVF was identified on echocardiography and located in the posterior aspect of the aortic root, expanding in systole and collapsing in diastole. Of the 9 cases examined, 8 were associated with endocarditis and 1 was caused by radio frequency catheter ablation of atrial fibrillation. Five cases were associated with bicuspid aortic valve, and rupture of P-MAIVF was identified in 3 patients. The morphology of P-MAIVF was clearly demonstrated on 3D echocardiography in 5 cases. In conclusion, echocardiography provides a useful tool in the diagnosis of P-MAIVF. Color Doppler flow imaging can ease identification of the ostium in cases of ruptured pseudoaneurysms. Three-dimensional echocardiography shows the relationship between P-MAIVF and the adjacent anatomic structures.
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Affiliation(s)
- Jiancheng Han
- From the Department of Ultrasound (JH, YH, XG, LS, YZ, WL, YZ, XY), Beijing Anzhen Hospital, Capital Medical University, Beijing Key Laboratory of Maternal-Fetus Medicine in Fetal Heart Disease, Chaoyang, Beijing, PR China; and Department of General Surgery and The Center for Fetal Research (YL), The Children's Hospital of Philadelphia, Philadelphia, PA
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40
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Indications de chirurgie en urgence des valvulopathies mitrales et aortiques. MEDECINE INTENSIVE REANIMATION 2016. [DOI: 10.1007/s13546-016-1173-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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41
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Amat-Santos IJ, Cortés C, Varela-Falcón LH. Delayed left anterior mitral leaflet perforation and infective endocarditis after transapical aortic valve implantation-Case report and systematic review. Catheter Cardiovasc Interv 2016; 89:951-954. [PMID: 26775197 DOI: 10.1002/ccd.26410] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 12/26/2015] [Indexed: 11/10/2022]
Abstract
AIM We aimed to illustrate the physiopathology of anterior mitral leaflet perforation after TAVI in patients suffering from infective endocarditis (IE). METHODS AND RESULTS The first known case of balloon-expandable transapical case from our series suffering from this complication was reported. In addition, a systematic electronic search of all published cases reporting both entities was performed. Five transfemoral cases have been published to the date, all males with mean age of 79.2 year (range: 66-88). Four were treated with self-expandable prostheses (deeply implanted in the outflow tract). There was moderate residual aortic regurgitation in four. Fever and positive blood cultures for typical micoorganisms were present at certain time point in all cases between the first week and up to 11 months (early IE). Three cases underwent cardiac surgery with adequate outcomes and two others died during hospitalization. Medical management in the case from our series allowed patient's survival at 1-year follow up. CONCLUSIONS Early suspicion of IE whenever anterior mitral perforation is found after TAVI can be life-saving. The hypothetical higher risk of this complication due to higher rate of aortic regurgitation has to be prevented through adequate prosthesis depth and careful sterile surgical technique. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
| | - Carlos Cortés
- Cardiology Department, Hospital Clínico Universitario De Valladolid, Spain
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42
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Çimen T, Doğan M, Kızıltepe U, Akyel A, Sunman H, Yeter E. Mitral-aortic intervalvular fibrosa pseudoaneurysm with rupture into the left atrium: a three-dimensional trans-esophageal echocardiographic approach. Anatol J Cardiol 2015; 15:1030-1. [PMID: 26663226 PMCID: PMC5368457 DOI: 10.5152/anatoljcardiol.2015.6663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Tolga Çimen
- Department of Cardiology, Dışkapı Yıldırım Beyazıt Education and Research Hospital; Ankara-Turkey.
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43
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A new entity in an immunosuppressive patient: Giant reverse kissing vegetation. Int J Cardiol 2015; 201:279-81. [DOI: 10.1016/j.ijcard.2015.08.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 08/06/2015] [Indexed: 11/22/2022]
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44
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Vilacosta I, Olmos C, de Agustín A, López J, Islas F, Sarriá C, Ferrera C, Ortiz-Bautista C, Sánchez-Enrique C, Vivas D, San Román A. The diagnostic ability of echocardiography for infective endocarditis and its associated complications. Expert Rev Cardiovasc Ther 2015; 13:1225-36. [PMID: 26471429 DOI: 10.1586/14779072.2015.1096780] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Echocardiography, transthoracic and transoesophageal, plays a key role in the diagnosis and prognosis assessment of patients with infective endocarditis. It constitutes a major Duke criterion and is pivotal in treatment guiding. Seven echocardiographic findings are major criteria in the diagnosis of infective endocarditis (IE) (vegetation, abscess, pseudoaneurysm, fistulae, new dehiscence of a prosthetic valve, perforation and valve aneurysm). Echocardiography must be performed as soon as endocarditis is suspected. Transoesophageal echocardiography should be done in most cases of left-sided endocarditis to better define the anatomic lesions and to rule out local complications. Transoesophageal echocardiography is not necessary in isolated right-sided native valve IE with good quality transthoracic examination and unequivocal echocardiographic findings. Echocardiography is a very useful tool to assess the prognosis of patients with IE at any time during the course of the disease. Echocardiographic predictors of poor outcome include presence of periannular complications, prosthetic dysfunction, low left ventricular ejection fraction, pulmonary hypertension and very large vegetations.
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Affiliation(s)
- Isidre Vilacosta
- a 1 Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - Carmen Olmos
- a 1 Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - Alberto de Agustín
- a 1 Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - Javier López
- b 2 Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Fabián Islas
- a 1 Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - Cristina Sarriá
- c 3 Servicio de Medicina Interna-Infecciosas, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa, Madrid, Spain
| | - Carlos Ferrera
- a 1 Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - Carlos Ortiz-Bautista
- b 2 Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - David Vivas
- a 1 Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - Alberto San Román
- b 2 Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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45
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De Vry DJ, Poblocki JR, Algahim MF, Hossein Almassi G, Pagel PS. Mechanism of Torrential Aortic Valve Insufficiency in Endocarditis: Leaflet Destruction, Restriction, Prolapse, or Perforation? J Cardiothorac Vasc Anesth 2015; 29:1734-6. [PMID: 26275515 DOI: 10.1053/j.jvca.2015.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Derek J De Vry
- Anesthesia, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Joseph R Poblocki
- Anesthesia, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Mohamed F Algahim
- Cardiothoracic Surgery Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - G Hossein Almassi
- Cardiothoracic Surgery Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Paul S Pagel
- Anesthesia, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI.
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46
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Seratnahaei A, Bailey AL, Hensley PJ, O'Connor W, Smith MD. Infective Endocarditis Complicated by Mitral Valve Aneurysm: Pathologic and Echocardiographic Correlations. Echocardiography 2015; 32:1417-22. [PMID: 25930970 DOI: 10.1111/echo.12958] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Infective endocarditis is a well-described cardiovascular disease that causes significant morbidity and mortality despite medical and surgical advances. Complications of endocarditis include heart failure, systemic embolization, and valvular destruction including valve aneurysms which increase morbidity and mortality. Mitral valve aneurysms are rarely encountered in the clinical setting. We present eight mitral valve aneurysm cases and discuss a new potential pathogenesis of this deadly endocarditis complication. Pathologic evaluation suggests that neovascularization of the anterior mitral valve leaflet predisposes this territory to abscess and aneurysm formation. In conclusion, mitral valve aneurysms appear to be another form of intravalvular abscess which has expanded and should be approached aggressively with surgical intervention if indicated.
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Affiliation(s)
- Arash Seratnahaei
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky Medical Center, Lexington, Kentucky
| | - Alison L Bailey
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky Medical Center, Lexington, Kentucky
| | - Patrick J Hensley
- Department of Pathology, University of Kentucky Medical Center, Lexington, Kentucky
| | - William O'Connor
- Department of Pathology, University of Kentucky Medical Center, Lexington, Kentucky
| | - Mikel D Smith
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky Medical Center, Lexington, Kentucky
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47
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Are novel non-invasive imaging techniques needed in patients with suspected prosthetic heart valve endocarditis? A systematic review and meta-analysis. Eur Radiol 2015; 25:2125-33. [PMID: 25680715 PMCID: PMC4457913 DOI: 10.1007/s00330-015-3605-7] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 11/10/2014] [Accepted: 01/15/2015] [Indexed: 12/12/2022]
Abstract
Objectives Multimodal non-invasive imaging plays a key role in establishing a diagnosis of PHV endocarditis. The objective of this study was to provide a systematic review of the literature and meta-analysis of the diagnostic accuracy of TTE, TEE, and MDCT in patients with (suspected) PHV endocarditis. Methods Studies published between 1985 and 2013 were identified via search and cross-reference of PubMed/Embase databases. Studies were included if (1) they reported on the non-invasive index tests TTE, TEE, or MDCT; (2) data was provided on PHV endocarditis as the condition of interest; and (3) imaging results were verified against either surgical inspection/autopsy or clinical follow-up reference standards, thereby enabling the extraction of 2-by-2 tables. Results Twenty articles (including 496 patients) met the inclusion criteria for PHV endocarditis. TTE, TEE, and MDCT + TEE had a pooled sensitivity/specificity for vegetations of 29/100 %; 82/95 %, and 88/94 %, respectively. The pooled sensitivity/specificity of TTE, TEE, and MDCT + TEE for periannular complications was 36/93 %, 86/98 %, and 100/94 %, respectively. Conclusions TEE showed good sensitivity and specificity for establishing a diagnosis of PHV endocarditis. Although MDCT data are limited, this review showed that MDCT in addition to TEE may improve sensitivity in detecting life-threatening periannular complications. Key Points • Multimodal imaging is an important ingredient of diagnostic workup for PHV endocarditis. • Transthoracic and transesophageal echography may miss life-threatening periannular complications. • MDCT can improve sensitivity for the detection of life-threatening periannular complications. Electronic supplementary material The online version of this article (doi:10.1007/s00330-015-3605-7) contains supplementary material, which is available to authorized users.
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48
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Pseudoaneurysm of the mitral-aortic intervalvular fibrosa. A new comprehensive review. Herz 2014; 40 Suppl 2:182-9. [PMID: 25468033 DOI: 10.1007/s00059-014-4185-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 10/13/2014] [Accepted: 11/02/2014] [Indexed: 10/24/2022]
Abstract
Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (P-MAIVF) is an infrequent but potentially life-threatening condition. Both transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) can detect P-MAIVF with sensitivity rates of 43 and 90 %, respectively. The typical finding of echocardiography is a pulsatile echo-free sac that expands in systole and collapses in diastole. Our review comprises 166 patients with P-MAIVF, including eight cases in our hospital and 158 cases from the literature. P-MAIVF is often associated with infection or surgical trauma. While it is likely to maintain an asymptomatic course, symptoms of shortness of breath, heart failure, valvular disease, chest pain, endocarditis, and cerebrovascular events are common clinical presentations. The recommended treatment is surgery. However, conservative therapy is an alternative approach for high-risk patients or when surgical treatment is refused. With the increasing incidence of cardiac surgery and infective endocarditis, a likely increment in the new diagnosis of pseudoaneurysm is expected.
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49
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Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, O’Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM, Thomas JD, Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Creager MA, Curtis LH, DeMets D, Guyton RA, Hochman JS, Kovacs RJ, Ohman EM, Pressler SJ, Sellke FW, Shen WK, Stevenson WG, Yancy CW. 2014 AHA/ACC guideline for the management of patients with valvular heart disease. J Thorac Cardiovasc Surg 2014; 148:e1-e132. [DOI: 10.1016/j.jtcvs.2014.05.014] [Citation(s) in RCA: 631] [Impact Index Per Article: 63.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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50
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Methangkool E, Howard-Quijano K, Ho JK, Mahajan A. Infective endocarditis: the importance of intraoperative transesophageal echocardiography. Anesth Analg 2014; 119:35-40. [PMID: 24945122 DOI: 10.1213/ane.0000000000000195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Emily Methangkool
- From the Department of Anesthesiology, University of California, Los Angeles, Los Angeles, California
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