1
|
El-Andari R, Fialka NM, Bozso SJ, Nagendran J. A multidisciplinary team approach to the long-term management of infective endocarditis: Complex management for complex patients. Int J Cardiol 2024; 404:131936. [PMID: 38447763 DOI: 10.1016/j.ijcard.2024.131936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 02/03/2024] [Accepted: 03/01/2024] [Indexed: 03/08/2024]
Affiliation(s)
- Ryaan El-Andari
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Nicholas M Fialka
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Sabin J Bozso
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Jeevan Nagendran
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
| |
Collapse
|
2
|
Dayer MJ, Quintero-Martinez JA, Thornhill MH, Chambers JB, Pettersson GB, Baddour LM. Recent Insights Into Native Valve Infective Endocarditis: JACC Focus Seminar 4/4. J Am Coll Cardiol 2024; 83:1431-1443. [PMID: 38599719 DOI: 10.1016/j.jacc.2023.12.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/27/2023] [Accepted: 12/05/2023] [Indexed: 04/12/2024]
Abstract
This focused review highlights the latest issues in native valve infective endocarditis. Native valve disease moderately increases the risk of developing infective endocarditis. In 2023, new diagnostic criteria were published by the Duke-International Society of Cardiovascular Infectious Diseases group. New pathogens were designated as typical, and findings on computed tomography imaging were included as diagnostic criteria. It is now recognized that a multidisciplinary approach to care is vital, and the role of an "endocarditis team" is highlighted. Recent studies have suggested that a transition from intravenous to oral antibiotics in selected patients may be reasonable, and the role of long-acting antibiotics is discussed. It is also now clear that an aggressive surgical approach can be life-saving in some patients. Finally, results of several recent studies have suggested there is an association between dental and other invasive procedures and an increased risk of developing infective endocarditis. Moreover, data indicate that antibiotic prophylaxis may be effective in some scenarios.
Collapse
Affiliation(s)
- Mark J Dayer
- Cardiovascular Research Institute, Mater Private Network, Dublin, Ireland; Faculty of Health, University of Plymouth, Plymouth, United Kingdom.
| | - Juan A Quintero-Martinez
- Department of Internal Medicine, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| | - Martin H Thornhill
- Department of Oral and Maxillofacial Medicine, Surgery and Pathology, School of Clinical Dentistry, University of Sheffield, Sheffield, United Kingdom
| | - John B Chambers
- Emeritus Professor of Clinical Cardiology at Guy's and St Thomas' NHS Trust, London, United Kingdom, and Kings College, London, United Kingdom
| | | | - Larry M Baddour
- Department of Medicine and Department of Cardiovascular Medicine, Division of Public Health, Infectious Diseases and Occupational Health, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
3
|
Martin O, Devejian N, Paul A, Randall J. Early Surgical Resection of Left Atrial Myxoma After Thromboembolic Stroke. World J Pediatr Congenit Heart Surg 2024; 15:245-247. [PMID: 38128923 DOI: 10.1177/21501351231214538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
We present a case report of a five-year-old male with acute ischemic stroke who underwent successful mechanical endovascular thrombectomy and early surgical resection of left atrial myxoma two days after onset of stroke symptoms without additional neurological sequelae.
Collapse
Affiliation(s)
- Olga Martin
- Department of Cardiothoracic Surgery, Albany Medical Center, Albany, NY, USA
| | - Neil Devejian
- Department of Pediatric Cardiac Surgery, Albany Medical Center, Albany, NY, USA
| | - Alexandra Paul
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
| | - Jess Randall
- Department of Pediatrics, Albany Medical Center, Albany, NY, USA
| |
Collapse
|
4
|
de Havenon A, Zhou LW, Koo AB, Matouk C, Falcone GJ, Sharma R, Ney J, Shu L, Yaghi S, Kamel H, Sheth KN. Endovascular Treatment of Acute Ischemic Stroke After Cardiac Interventions in the United States. JAMA Neurol 2024; 81:264-272. [PMID: 38285452 PMCID: PMC10825786 DOI: 10.1001/jamaneurol.2023.5416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/25/2023] [Indexed: 01/30/2024]
Abstract
Importance Ischemic stroke is a serious complication of cardiac intervention, including surgery and percutaneous procedures. Endovascular thrombectomy (EVT) is an effective treatment for ischemic stroke and may be particularly important for cardiac intervention patients who often cannot receive intravenous thrombolysis. Objective To examine trends in EVT for ischemic stroke during hospitalization of patients with cardiac interventions vs those without in the United States. Design, Setting, and Participants This cohort study involved a retrospective analysis using data for 4888 US hospitals from the 2016-2020 National Inpatient Sample database. Participants included adults (age ≥18 years) with ischemic stroke (per codes from the International Statistical Classification of Diseases, Tenth Revision, Clinical Modification), who were organized into study groups of hospitalized patients with cardiac interventions vs without. Individuals were excluded from the study if they had either procedure prior to admission, EVT prior to cardiac intervention, EVT more than 3 days after admission or cardiac intervention, or endocarditis. Data were analyzed from April 2023 to October 2023. Exposures Cardiac intervention during admission. Main Outcomes and Measures The odds of undergoing EVT by cardiac intervention status were calculated using multivariable logistic regression. Adjustments were made for stroke severity in the subgroup of patients who had a National Institutes of Health Stroke Scale (NIHSS) score documented. As a secondary outcome, the odds of discharge home by EVT status after cardiac intervention were modeled. Results Among 634 407 hospitalizations, the mean (SD) age of the patients was 69.8 (14.1) years, 318 363 patients (50.2%) were male, and 316 044 (49.8%) were female. A total of 12 093 had a cardiac intervention. An NIHSS score was reported in 218 576 admissions, 216 035 (34.7%) without cardiac intervention and 2541 (21.0%) with cardiac intervention (P < .001). EVT was performed in 23 660 patients (3.8%) without cardiac intervention vs 194 (1.6%) of those with cardiac intervention (P < .001). After adjustment for potential confounders, EVT was less likely to be performed in stroke patients with cardiac intervention vs those without (adjusted odds ratio [aOR], 0.27; 95% CI, 0.23-0.31), which remained consistent after adjusting for NIHSS score (aOR, 0.28; 95% CI, 0.22-0.35). Among individuals with a cardiac intervention, receiving EVT was associated with a 2-fold higher chance of discharge home (aOR, 2.21; 95% CI, 1.14-4.29). Conclusions and Relevance In this study, patients hospitalized with ischemic stroke and cardiac intervention may be less than half as likely to receive EVT as those without cardiac intervention. Given the known benefit of EVT, there is a need to better understand the reasons for lower rates of EVT in this patient population.
Collapse
Affiliation(s)
- Adam de Havenon
- Department of Neurology, Center for Brain and Mind Health, Yale University, New Haven, Connecticut
| | - Lily W. Zhou
- Department of Neurology, The University of British Columbia, Vancouver, Canada
| | - Andrew B. Koo
- Department of Neurosurgery, Yale University, New Haven, Connecticut
| | - Charles Matouk
- Department of Neurosurgery, Yale University, New Haven, Connecticut
| | - Guido J. Falcone
- Department of Neurology, Center for Brain and Mind Health, Yale University, New Haven, Connecticut
| | - Richa Sharma
- Department of Neurology, Center for Brain and Mind Health, Yale University, New Haven, Connecticut
| | - John Ney
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Liqi Shu
- Department of Neurology, Brown University, Providence, Rhode Island
| | - Shadi Yaghi
- Department of Neurology, Brown University, Providence, Rhode Island
| | - Hooman Kamel
- Department of Neurology, Weill Cornell Medicine, New York, New York
- Deputy Editor, JAMA Neurology
| | - Kevin N. Sheth
- Department of Neurology, Center for Brain and Mind Health, Yale University, New Haven, Connecticut
| |
Collapse
|
5
|
De Cristofaro J, Sacchi S, Baldetti L, Calvo F, Gramegna M, Pazzanese V, Peveri B, Cianfanelli L, Ajello S, Scandroglio AM. Cat Scratch Endocarditis. JACC Case Rep 2024; 29:102201. [PMID: 38361554 PMCID: PMC10865220 DOI: 10.1016/j.jaccas.2023.102201] [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] [Received: 09/21/2023] [Revised: 11/21/2023] [Accepted: 12/11/2023] [Indexed: 02/17/2024]
Abstract
We reported a case of blood culture-negative infective endocarditis on a native valve, where the clinical presentation was exclusively related to extensive cerebral ischemia secondary to multiple systemic septic cardioembolic events. The cause was ascribed to subacute Bartonella henselae infection, presumably transmitted by cat scratch, documented by positive serologic findings.
Collapse
Affiliation(s)
| | - Stefania Sacchi
- Cardiac Intensive Care Unit, San Raffaele University Hospital, Milan, Italy
| | - Luca Baldetti
- Cardiac Intensive Care Unit, San Raffaele University Hospital, Milan, Italy
| | - Francesco Calvo
- Cardiac Intensive Care Unit, San Raffaele University Hospital, Milan, Italy
| | - Mario Gramegna
- Cardiac Intensive Care Unit, San Raffaele University Hospital, Milan, Italy
| | - Vittorio Pazzanese
- Cardiac Intensive Care Unit, San Raffaele University Hospital, Milan, Italy
| | - Beatrice Peveri
- Cardiac Intensive Care Unit, San Raffaele University Hospital, Milan, Italy
| | | | - Silvia Ajello
- Cardiac Intensive Care Unit, San Raffaele University Hospital, Milan, Italy
| | | |
Collapse
|
6
|
Judd D, Oldham J, Lish J. Septic Embolic Encephalitis Following Cardiac Valve Replacement. Cureus 2024; 16:e51628. [PMID: 38313955 PMCID: PMC10837647 DOI: 10.7759/cureus.51628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2024] [Indexed: 02/06/2024] Open
Abstract
This paper presents a detailed case study of a 48-year-old male who underwent ascending aortic aneurysm repair with a bioprosthetic valve five years prior and subsequently developed septic embolic encephalitis, an infrequent yet critical complication following cardiac valve replacement. The patient exhibited an array of initial symptoms, including generalized weakness, fatigue, fevers, chills, diarrhea, and altered mentation. Microbiological analysis of blood cultures revealed the presence of Enterococcus, and echocardiogram examination demonstrated vegetation on the prosthetic valve. To assess disease progression, diagnostic imaging, including CT scans and MRIs, was conducted at various time points. The imaging results unveiled several abnormalities, including subarachnoid and parenchymal bleeding, cortical infarcts, cerebritis, and meningitis. Additionally, splenic and renal infarcts were observed through an abdominal CT scan. This case report accentuates the paramount role of diagnostic imaging in corroborating suspected septic embolic encephalitis while underscoring the significance of appropriate management of patients with a history of cardiac valve replacement, thereby emphasizing the urgency of timely intervention.
Collapse
Affiliation(s)
- Dallin Judd
- Medicine, Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, USA
| | - Jake Oldham
- Medicine, Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, USA
| | - James Lish
- Neuroradiology, Chandler Radiology Associates, Chandler, USA
| |
Collapse
|
7
|
Gill GS, Chakrala T, Kanmanthareddy A, Alla VM. Transcatheter vacuum aspiration of valvular and lead related infective endocarditis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 57:8-15. [PMID: 37331887 DOI: 10.1016/j.carrev.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Transcatheter aspiration is utilized for removal of thrombi and vegetations in inoperable patients and high-risk surgical candidates where medical therapy alone is unlikely to achieve desired outcome. A number of case reports and series have been published since the introduction of AngioVac system (AngioDynamics Inc., Latham, NY) in 2012 where this technology was used in the treatment of endocarditis. However, there is a lack of consolidated data reporting on patient selection, safety and outcomes. METHODS PubMed and Google Scholar databases were queried for publications reporting cases where transcatheter aspiration was used for endocarditis vegetation debulking or removal. Data on patient characteristics, outcomes and complications from select reports were extracted and systematically reviewed. RESULTS Data from 11 publications with 232 patients were included in the final analyses. Of these, 124 had lead vegetation aspiration, 105 had valvular vegetation aspiration, and 3 had both lead as well as valvular vegetation aspiration. Among the 105 valvular endocarditis cases, 102 (97 %) patients had right sided vegetation removal. Patients with valvular endocarditis were younger (mean age 35 years) vs. patients with lead vegetations (mean age 66 years). Among the valvular endocarditis cases, there was a 50-85 % reduction in vegetation size, 14 % had worsening valvular regurgitation, 8 % had persistent bacteremia and 37 % required blood transfusion. Surgical valve repair or replacement was subsequently performed in 3 % and in-hospital mortality was 11 %. Among patients with lead infection, procedural success rate was reported at 86 %, 2 % had vascular complications and in-hospital mortality was 6 %. Persistent bacteremia, renal failure requiring hemodialysis, and clinically significant pulmonary embolism occurred in about 1 % each. CONCLUSIONS Transcatheter aspiration of vegetations in infective endocarditis has acceptable success rates in vegetation debulking as well as rates of morbidity or mortality. Large prospective multi-center studies are warranted to determine predictors of complications, thus helping identify suitable patients.
Collapse
Affiliation(s)
- Gauravpal S Gill
- Division of Cardiovascular Disease, Creighton University School of Medicine, Omaha, NE, USA
| | - Teja Chakrala
- Department on Medicine, University of Florida, Gainesville, FL, USA
| | - Arun Kanmanthareddy
- Division of Cardiovascular Disease, Creighton University School of Medicine, Omaha, NE, USA
| | - Venkata Mahesh Alla
- Division of Cardiovascular Disease, Creighton University School of Medicine, Omaha, NE, USA.
| |
Collapse
|
8
|
Sambola A, Lozano-Torres J, Boersma E, Olmos C, Ternacle J, Calvo F, Tribouilloy C, Reskovic-Luksic V, Separovic-Hanzevacki J, Park SW, Bekkers S, Chan KL, Almaghraby A, Iung B, Lancellotti P, Habib G. Predictors of embolism and death in left-sided infective endocarditis: the European Society of Cardiology EURObservational Research Programme European Infective Endocarditis registry. Eur Heart J 2023; 44:4566-4575. [PMID: 37592753 DOI: 10.1093/eurheartj/ehad507] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 07/17/2023] [Accepted: 07/25/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND AND AIMS Even though vegetation size in infective endocarditis (IE) has been associated with embolic events (EEs) and mortality risk, it is unclear whether vegetation size associated with these potential outcomes is different in left-sided IE (LSIE). This study aimed to seek assessing the vegetation cut-off size as predictor of EE or 30-day mortality for LSIE and to determine risk predictors of these outcomes. METHODS The European Society of Cardiology EURObservational Research Programme European Infective Endocarditis is a prospective, multicentre registry including patients with definite or possible IE throughout 2016-18. Cox multivariable logistic regression analysis was performed to assess variables associated with EE or 30-day mortality. RESULTS There were 2171 patients with LSIE (women 31.5%). Among these affected patients, 459 (21.1%) had a new EE or died in 30 days. The cut-off value of vegetation size for predicting EEs or 30-day mortality was >10 mm [hazard ratio (HR) 1.38, 95% confidence interval (CI) 1.13-1.69, P = .0015]. Other adjusted predictors of risk of EE or death were as follows: EE on admission (HR 1.89, 95% CI 1.54-2.33, P < .0001), history of heart failure (HR 1.53, 95% CI 1.21-1.93, P = .0004), creatinine >2 mg/dL (HR 1.59, 95% CI 1.25-2.03, P = .0002), Staphylococcus aureus (HR 1.36, 95% CI 1.08-1.70, P = .008), congestive heart failure (HR 1.40, 95% CI 1.12-1.75, P = .003), presence of haemorrhagic stroke (HR 4.57, 95% CI 3.08-6.79, P < .0001), alcohol abuse (HR 1.45, 95% CI 1.04-2.03, P = .03), presence of cardiogenic shock (HR 2.07, 95% CI 1.29-3.34, P = .003), and not performing left surgery (HR 1.30 95% CI 1.05-1.61, P = .016) (C-statistic = .68). CONCLUSIONS Prognosis after LSIE is determined by multiple factors, including vegetation size.
Collapse
Affiliation(s)
- Antonia Sambola
- Department of Cardiology and Research Institute, Cardiac Intensive Care Unit, University Hospital Valld'Hebron, Universitat Autònoma, CIBER Cardiovascular Diseases (CIBER-CV), P° Vall d'Hebron, 119-129, Barcelona 08035, Spain
| | - Jordi Lozano-Torres
- Department of Cardiology and Research Institute, Cardiac Intensive Care Unit, University Hospital Valld'Hebron, Universitat Autònoma, CIBER Cardiovascular Diseases (CIBER-CV), P° Vall d'Hebron, 119-129, Barcelona 08035, Spain
| | - Eric Boersma
- Department of Cardiology, Erasmus MC Cardiovascular Institute, University Medical Center Rotterdam, BOX 2040, 3000 CA, Rotterdam, The Netherlands
| | - Carmen Olmos
- Instituto cardiovascular, Hospital Clínico San Carlos, Instituto de investigación Sanitaria del Hospital Clínico San Carlos, Prof. Martín Lagos s/n, 28040 Madrid, Spain
| | - Julien Ternacle
- Department of Cardiology, SOS Endocarditis, Henri Mondor University Hospital, Creteil, France
| | - Francisco Calvo
- Department of Cardiology, Hospital Universitario Alvaro Cunqueiro, Vigo, Spain
| | | | - Vlatka Reskovic-Luksic
- Department of Cardiovascular Diseases, School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | | | - Seung-Woo Park
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sebastiaan Bekkers
- Cardiovascular Research Institute Maastricht (CAARIM), Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - Kwan-Leung Chan
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | - Bernard Iung
- Cardiology Department, AP-HP, Hôpital Bichat, Paris, France
| | - Patrizio Lancellotti
- ANMCO Research Center, Florence, Italy
- Department of Cardiology, Heart valve Clinic, University of Liege Hospital, Liege, Belgium
| | - Gilbert Habib
- Cardiology Department, APHM, La Timone Hospital, Marseille, France
- Aix Marseille University, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| |
Collapse
|
9
|
Gilbey T, Milne B, de Somer F, Kunst G. Neurologic complications after cardiopulmonary bypass - A narrative review. Perfusion 2023; 38:1545-1559. [PMID: 35986553 PMCID: PMC10612382 DOI: 10.1177/02676591221119312] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
Neurologic complications, associated with cardiac surgery and cardiopulmonary bypass (CPB) in adults, are common and can be devastating in some cases. This comprehensive review will not only consider the broad categories of stroke and neurocognitive dysfunction, but it also summarises other neurological complications associated with CPB, and it provides an update about risks, prevention and treatment. Where appropriate, we consider the impact of off-pump techniques upon our understanding of the contribution of CPB to adverse outcomes.
Collapse
Affiliation(s)
- Tom Gilbey
- Department of Anaesthesia & Pain Medicine, King’s College Hospital NHS Foundation Trust, London, UK
| | - Benjamin Milne
- Department of Anaesthesia & Pain Medicine, King’s College Hospital NHS Foundation Trust, London, UK
| | - Filip de Somer
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
| | - Gudrun Kunst
- Department of Anaesthesia & Pain Medicine, King’s College Hospital NHS Foundation Trust, London, UK
- School of Cardiovascular Medicine and Sciences, Faculty of Life Sciences and Medicine, King’s College London British Heart Foundation Centre of Excellence, London, UK
| |
Collapse
|
10
|
Delgado V, Ajmone Marsan N, de Waha S, Bonaros N, Brida M, Burri H, Caselli S, Doenst T, Ederhy S, Erba PA, Foldager D, Fosbøl EL, Kovac J, Mestres CA, Miller OI, Miro JM, Pazdernik M, Pizzi MN, Quintana E, Rasmussen TB, Ristić AD, Rodés-Cabau J, Sionis A, Zühlke LJ, Borger MA. 2023 ESC Guidelines for the management of endocarditis. Eur Heart J 2023; 44:3948-4042. [PMID: 37622656 DOI: 10.1093/eurheartj/ehad193] [Citation(s) in RCA: 186] [Impact Index Per Article: 186.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
|
11
|
Weber C, Hohmann C, Lindner O, Wahlers T, Jung N. Patients with Artificial Heart Valves. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:692-702. [PMID: 37427994 PMCID: PMC10666258 DOI: 10.3238/arztebl.m2023.0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 04/19/2023] [Accepted: 04/19/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND In Germany, a total of 38 547 heart valve procedures were performed in 2022. With a growing number of patients undergoing the surgical and interventional implantation of heart valves, the incidence of prosthetic endocarditis is also rising. METHODS We summarize the current state of the prophylaxis, diagnosis, and treatment of prosthetic endocarditis in a selective review of the literature. RESULTS Prosthetic endocarditis accounts for 10-30% of all cases of endocarditis. As its echocardiographic and microbiologic findings are often less specific than those of native endocarditis, its diagnosis now increasingly relies on alternative imaging modalities such as F-18-FDG PET-CT. Anti-infective and surgical treatment are made more difficult by biofilm formation on the prosthetic valve and the frequent formation of perivalvular abscesses. CONCLUSION Increased awareness of this clinical entity in the outpatient setting will promote the earlier initiation of appropriate diagnostic studies. Proper diagnostic evaluation is an essential prerequisite for the early detection and timely treatment of prosthetic endocarditis, with the goal of preventing progressive destruction and thus improving the outcome. Preventive and educative measures should be intensified, and certified, multidisciplinary endocarditis teams should be established. Antibiotic prophylaxis is now given much more restrictively than in earlier years; the risk of infection must be weighed against the potential development of both individual and collective resistance to antibiotic drugs.
Collapse
Affiliation(s)
- Carolyn Weber
- Department of Cardiothoracic Surgery, Heart Center, University Hospital Cologne
| | - Christopher Hohmann
- Department III for Internal Medicine – General and Interventional Cardiology, Electrophysiology, Angiology, Pneumology and Intensive Care Medicine, University Hospital Cologne
| | - Oliver Lindner
- Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine-Westphalia, University Hospital Ruhr-University Bochum, Bad Oeynhausen-Universität Bochum
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heart Center, University Hospital Cologne
| | - Norma Jung
- Department I of Internal Medicine – Oncology, Hematology, Division of Infectious Diseases, Clinical Immunology, Hemostaseology and internal Intensive Care Medicine, University Hospital Cologne
| |
Collapse
|
12
|
Zhu X, Wang Z, Ferrari MW, Ferrari-Kuehne K, Hsi DH, Tse G, Zhou Q, Liang H, Zhang Y, Zhang J. Management of anticoagulation in patients with infective endocarditis. Thromb Res 2023; 229:15-25. [PMID: 37390524 DOI: 10.1016/j.thromres.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 06/05/2023] [Accepted: 06/09/2023] [Indexed: 07/02/2023]
Abstract
Infective endocarditis (IE) carries a high risk of vascular complications (e.g., cerebral embolism, intracerebral hemorrhage, and renal infarction), which are correlated with increased early and late mortality. Although anticoagulation is the cornerstone for management of thromboembolic complications, it remains controversial and challenging in patients with IE. An appropriate anticoagulation strategy is crucial to improving outcomes and requires a good understanding of the indication, timing, and regimen of anticoagulation in the setting of IE. Observational studies have shown that anticoagulant treatment failed to reduce the risk of ischemic stroke in patents with IE, supporting that IE alone is not an indication for anticoagulation. In the absence of randomized controlled trials and high-quality meta-analyses, however, current guidelines on IE were based largely on observational data and expert opinion, providing few specific recommendations on anticoagulation. A multidisciplinary approach and patient engagement are required to determine the timing and regimen of anticoagulation in patients with IE, especially in specific situations (e.g., receiving warfarin anticoagulation at the time of IE diagnosis, cerebral embolism or ischemic stroke, intracerebral hemorrhage, or urgent surgery). Collectively, individualized strategies on anticoagulation management of IE should be based on clinical evaluation, available evidence, and patient engagement, and ultimately be developed by the multidisciplinary team.
Collapse
Affiliation(s)
- Xiaogang Zhu
- Department of Cardiology, Fu Xing Hospital, Capital Medical University, China
| | - Zhenhua Wang
- Department of Cardiology, Second Affiliated Hospital of Fujian Medical University, China
| | - Markus W Ferrari
- Clinic of Internal Medicine 1, HSK, Clinic of the City of Wiesbaden and the HELIOS Group, Germany
| | | | - David H Hsi
- Heart & Vascular Institute, Stamford Hospital, Stamford, CT, United States
| | - Gary Tse
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Quanzhong Zhou
- Department of Radiology, The Center for Medical Imaging of Guizhou Province, Affiliated Hospital of Zunyi Medical University, China
| | - Haifeng Liang
- Department of Cardiology, Fu Xing Hospital, Capital Medical University, China
| | - Yuhui Zhang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, China.
| | - Jian Zhang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, China.
| |
Collapse
|
13
|
Kremer J, Jahn J, Klein S, Farag M, Borst T, Karck M. Early versus Delayed Surgery in Patients with Left-Sided Infective Endocarditis and Stroke. J Cardiovasc Dev Dis 2023; 10:356. [PMID: 37623369 PMCID: PMC10455129 DOI: 10.3390/jcdd10080356] [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: 07/25/2023] [Revised: 08/13/2023] [Accepted: 08/17/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Timing of surgery remains controversial in patients with infective endocarditis and stroke. Guidelines on infective endocarditis suggest delaying surgery for up to 4 weeks. However, with early heart failure due to progression of the infection or recurrent septic embolism, urgent surgery becomes imperative. METHODS Out of 688 patients who were surgically treated for left-sided infective endocarditis, 187 presented with preoperative neurological events. The date of cerebral stroke onset was documented in 147 patients. The patients were stratified according to timing of surgery: 61 in the early group (0-7 days) vs. 86 in the delayed group (>7 days). Postoperative neurological outcome was assessed by the modified Rankin Scale. RESULTS Preoperative sepsis was more prevalent in patients with preoperative neurological complications (46.0% vs. 29.5%, p < 0.001). Patients with haemorrhagic stroke were operated on later (19.8% vs. 3.3%, p = 0.003). Postoperative cerebrovascular accidents were comparable between both groups (p = 0.13). Overall, we observed good neurological outcomes (p = 0.80) and a high recovery rate, with only 5% of cases showing neurological deterioration after surgery (p = 0.29). In-hospital mortality and long-term survival were not significantly different in the early and delayed surgery groups (log-rank, p = 0.22). CONCLUSIONS Early valve surgery in high-risk patients with infective endocarditis and stroke can be performed safely and is not associated with worse outcomes.
Collapse
Affiliation(s)
- Jamila Kremer
- Department of Cardiac Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
| | - Joshua Jahn
- Department of Cardiac Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
| | - Sabrina Klein
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany
| | - Mina Farag
- Department of Cardiac Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
| | - Tobias Borst
- Pharmacy Department, Erlangen University Hospital, Palmsanlage 3, 91054 Erlangen, Germany
| | - Matthias Karck
- Department of Cardiac Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
| |
Collapse
|
14
|
Jhawar N, El Sabbagh A. 86-Year-Old Woman With Fever, New-Onset Dysarthria, and Ataxia. Mayo Clin Proc 2023; 98:1235-1240. [PMID: 37536807 DOI: 10.1016/j.mayocp.2022.12.029] [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: 10/12/2022] [Revised: 12/15/2022] [Accepted: 12/23/2022] [Indexed: 08/05/2023]
Affiliation(s)
- Nikita Jhawar
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Jacksonville, FL
| | - Abdallah El Sabbagh
- Advisor to resident and Consultant in Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL.
| |
Collapse
|
15
|
Benvenga RM, Tribouilloy C, Michelena HI, Silverio A, Arregle F, Martel H, Denev S, Bohbot Y, Hubert S, Renard S, Camoin L, Casalta AC, Casalta JP, Gouriet F, Riberi A, Lepidi H, Collart F, Raoult D, Drancourt M, Galasso G, DeSimone DC, Citro R, Habib G. Clinical and Echocardiographic Features of Patients With Infective Endocarditis and Bicuspid Aortic Valve According to Echocardiographic Definition of Valve Morphology. J Am Soc Echocardiogr 2023; 36:760-768. [PMID: 36682434 DOI: 10.1016/j.echo.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 01/14/2023] [Accepted: 01/14/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND The influence of different bicuspid aortic valve (BAV) morphology in the clinical course of infective endocarditis (IE) has not yet been investigated. This study aimed to describe the clinical and echocardiographic features of IE in patients with BAV (BAVIE) according to valve morphology. METHODS Patients with definite BAVIE prospectively enrolled in 4 high-volume referral centers from 2000 to 2019 were evaluated and divided into 2 groups according to the echocardiographic definition of fused BAV morphology: right-left coronary (RL type) and right noncoronary or left noncoronary (non-RL type) cusp fusion. All patients were followed up for 1 year. RESULTS One hundred thirty-eight patients with BAVIE were included (77.7% male; median age, 52 [36.83-61.00] years): 112 patients with RL type (81%) and 26 patients with non-RL type BAV (19%), with no significant differences in age, sex, and comorbidities between groups. Although 43% of the cohort had known BAV, the referral was late after symptom onset, particularly for the RL phenotype; time from symptom onset to hospitalization >30 days (31.3% vs 11.5%; P = .032) and New York Heart Association class ≥ II (64.3% vs 42.3%; P = .039) were more frequent in patients with RL type BAV than in patients with non-RL type BAV. Conversely, patients with non-RL type BAV had a higher incidence of hemorrhagic stroke (19.2% vs 5.4%; P = .034) and high-grade atrioventricular block (11.5% vs 0.9%; P = .021). Streptococcus viridans was more frequently isolated in patients with non-RL type BAV than in patients with RL type BAV (44% vs 24.1%; P = .045). No difference in short- and intermediate-term mortality was observed between groups. CONCLUSIONS Clinical profile and echocardiographic features in BAVIE patients may differ according to valve morphology, and patients with BAVIE appear to be referred late, even when BAV disease is previously known.
Collapse
Affiliation(s)
- Rossella Maria Benvenga
- Cardiology Department, APHM, La Timone Hospital, Marseille, France; Heart Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | | | | | - Angelo Silverio
- Heart Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Florent Arregle
- Cardiology Department, APHM, La Timone Hospital, Marseille, France
| | - Hélène Martel
- Cardiology Department, APHM, La Timone Hospital, Marseille, France
| | - Seyhan Denev
- Department of Cardiology Amiens University Hospital Amiens, Amiens, France
| | - Yohann Bohbot
- Department of Cardiology Amiens University Hospital Amiens, Amiens, France
| | - Sandrine Hubert
- Cardiology Department, APHM, La Timone Hospital, Marseille, France
| | - Sébastien Renard
- Cardiology Department, APHM, La Timone Hospital, Marseille, France
| | - Laurence Camoin
- Aix Marseille University, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | | | - Jean Paul Casalta
- Aix Marseille University, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Frédérique Gouriet
- Aix Marseille University, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Alberto Riberi
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | - Hubert Lepidi
- Aix Marseille University, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Frederic Collart
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | - Didier Raoult
- Aix Marseille University, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Michel Drancourt
- Aix Marseille University, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Gennaro Galasso
- Heart Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Daniel C DeSimone
- Department of Cardiovascular Medicine Mayo Clinic, Rochester, Minnesota
| | - Rodolfo Citro
- Heart Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy; IRCCS Neuromed, Pozzilli, Isernia, Italy.
| | - Gilbert Habib
- Cardiology Department, APHM, La Timone Hospital, Marseille, France; Aix Marseille University, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| |
Collapse
|
16
|
Sharma M, Davis AP. Adding Fuel to the Fire: Infective Endocarditis and the Challenge of Cerebrovascular Complications. Curr Cardiol Rep 2023; 25:349-356. [PMID: 36971959 DOI: 10.1007/s11886-023-01856-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2023] [Indexed: 05/16/2023]
Abstract
PURPOSE OF REVIEW Infective endocarditis is a deadly disease and made more deadly by neurologic complications. We review the cerebrovascular complications of infective endocarditis and focus our discussion on medical and surgical management. RECENT FINDINGS While management of stroke in the setting of infective endocarditis differs from standard stroke treatment, mechanical thrombectomy has proven safe and successful. Optimal timing of cardiac surgery in the setting of stroke remains an area of debate, but additional observational studies continue to add more detail to the discussion. Cerebrovascular complications in the setting of infective endocarditis remain a high stakes clinical challenge. Timing of cardiac surgery in IE complicated by stroke exemplifies these dilemmas. While more studies have suggested that earlier cardiac surgery is likely safe for those with small ischemic infarcts, there remains a need for more data defining optimal timing of surgery in all forms of cerebrovascular involvement.
Collapse
Affiliation(s)
- Malveeka Sharma
- Department of Neurology, Harborview Medical Center, University of Washington, 325 Ninth Avenue, Box 359775, Seattle, WA, 98104-2420, USA
| | - Arielle P Davis
- Department of Neurology, Harborview Medical Center, University of Washington, 325 Ninth Avenue, Box 359775, Seattle, WA, 98104-2420, USA.
| |
Collapse
|
17
|
Williams TJ, Starr M, El-Dalati S. Intracranial Hemorrhage as a Marker for Mycotic Aneurysm in Patients With Infective Endocarditis. Neurol Clin Pract 2023; 13:e200144. [PMID: 37064584 PMCID: PMC10100440 DOI: 10.1212/cpj.0000000000200144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/09/2023] [Indexed: 03/12/2023]
Abstract
Background and Objective Mycotic aneurysms are a significant complication of IE that can lead to intracranial hemorrhage (ICH) and occasionally require intervention before valve surgery. Digital subtraction angiography (DSA) remains the gold standard for the detection of mycotic aneurysms but is an invasive procedure with contrasted dye exposure. Our objective was to determine predictive factors for the presence of mycotic aneurysms in patients with known infective endocarditis (IE). Methods IRB exemption was obtained from the University of Pittsburgh Medical Center. Patients with left-sided or right-sided endocarditis with patent foramen ovale (PFO) were identified. Records were retrospectively reviewed by an independent investigator. Patients were stratified by demographic information, diagnostic imaging, and clinical outcomes. Standard descriptive statistics were used for characterization. The χ2 analysis and Fisher exact test were used for categorical comparisons. The Student t test was used for group comparisons. Results 36 cases of left-sided or right-sided endocarditis with PFO undergoing evaluation for valve surgery were identified. Twenty-seven patients underwent CNS imaging, and 24 underwent DSA. Six patients were found to have ICH on CNS imaging. Mycotic aneurysms were identified by DSA in 5 patients (13.9%), and of these patients, 4 (80%) presented with ICH and 1 with ischemic stroke. Notably, the patient who presented with ischemic stroke then developed ICH on follow-up CT imaging. The negative predictive value of the absence of ICH on initial CNS imaging for the presence of mycotic aneurysm was 97.4%. Discussion Patients with left-sided and right-sided endocarditis with PFO and ICH on CNS imaging were more likely to have mycotic aneurysms detected through DSA than similar patients without ICH. Routine DSA screening for mycotic aneurysms may not be required in patients with endocarditis undergoing evaluation for valve surgery who present without ICH on CNS imaging.
Collapse
Affiliation(s)
- Thomas J Williams
- Department of Neurology (TJW, MS), University of Pittsburgh Medical Center, Pittsburgh, PA; Division of Infectious Diseases, Department of Internal Medicine, (SE-D) University of Kentucky Medical Center, Lexington, KY
| | - Matthew Starr
- Department of Neurology (TJW, MS), University of Pittsburgh Medical Center, Pittsburgh, PA; Division of Infectious Diseases, Department of Internal Medicine, (SE-D) University of Kentucky Medical Center, Lexington, KY
| | - Sami El-Dalati
- Department of Neurology (TJW, MS), University of Pittsburgh Medical Center, Pittsburgh, PA; Division of Infectious Diseases, Department of Internal Medicine, (SE-D) University of Kentucky Medical Center, Lexington, KY
| |
Collapse
|
18
|
Bellamy SE, Ott W, Kolb JD, Malik K. A Complicated Clinical Course of Community-Acquired Staphylococcus aureus Infective Endocarditis. Cureus 2023; 15:e35973. [PMID: 37041901 PMCID: PMC10082973 DOI: 10.7759/cureus.35973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2023] [Indexed: 03/12/2023] Open
Abstract
Infective endocarditis (IE) is an infection of the heart's endocardial surface, heart valves, or implanted cardiac devices, with the most common causative organism being Staphylococcus aureus. The clinical presentation of IE can be variable, with some patients presenting with multisystemic complications, including renal, pulmonary, cutaneous, and neurologic complications. Cerebral infarction is the most common complication of IE. Here we present a case of a young male with S. aureus IE of a native cardiac valve who developed multiple complications during his clinical course.
Collapse
|
19
|
Postpartum Endocarditis and Left Main Embolization. CJC Open 2022; 4:1096-1099. [PMID: 36562016 PMCID: PMC9764111 DOI: 10.1016/j.cjco.2022.09.003] [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: 05/30/2022] [Accepted: 09/19/2022] [Indexed: 12/25/2022] Open
Abstract
Postpartum infective endocarditis is a rare disease, especially in people with no risk factors (ie, intravenous drug use), that can be followed by severe morbidity and mortality. Here, we report a case of postpartum infective endocarditis with an unusual acute coronary syndrome-like presentation in a patient with minimal risk factors. In addition to lesions on the aortic valve causing severe aortic insufficiency, the patient's case was also complicated by left main coronary artery embolization, which was subsequently aspirated during surgery. Repeat angiography demonstrated complete removal, with no evidence of downstream embolization.
Collapse
|
20
|
Optimal Timing for Cardiac Surgery in Infective Endocarditis with Neurological Complications: A Narrative Review. J Clin Med 2022; 11:jcm11185275. [PMID: 36142922 PMCID: PMC9501443 DOI: 10.3390/jcm11185275] [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: 07/04/2022] [Revised: 08/26/2022] [Accepted: 09/01/2022] [Indexed: 11/17/2022] Open
Abstract
In patients with infective endocarditis and neurological complications, the optimal timing for cardiac surgery is unclear due to the varied risk of clinical deterioration when early surgery is performed. The aim of this review is to summarize the best evidence on the optimal timing for cardiac surgery in the presence of each type of neurological complication. An English literature search was carried out from June 2018 through July 2022. The resulting selection, comprising observational studies, clinical trials, systematic reviews and society guidelines, was organized into four sections according to the four groups of neurological complications: ischemic, hemorrhagic, infectious, and asymptomatic complications. Cardiac surgery could be performed without delay in cases of ischemic vascular neurological complication (provided the absence of severe damage, which can be avoided with the performance of mechanical thrombectomy in cases of major stroke), as well as infectious or asymptomatic complications. In the presence of intracranial hemorrhage, a delay of four weeks is recommended for most cases, although recent studies have suggested that performing cardiac surgery within four weeks could be a suitable option for selected cases. The findings of this review are mostly in line with the recommendations of the current European and American infective endocarditis guidelines.
Collapse
|
21
|
Chen L, Zhang P, Zhu X, Zhang M, Deng B. A Cryptogenic Stroke Associated With Infective Endocarditis and Antiphospholipid Antibody Syndrome: Case Report and Literature Review. Front Neurol 2022; 13:872279. [PMID: 35959388 PMCID: PMC9358978 DOI: 10.3389/fneur.2022.872279] [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: 02/09/2022] [Accepted: 06/22/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Accurate definition of stroke etiology is crucial, as this will guide effective targets for treatment. Both antiphospholipid antibody syndrome (APS) and infective endocarditis (IE) can be independent risk factors for ischemic stroke in young adults. When an embolic stroke occurs with IE and APS simultaneously, the origin of the embolic source is difficult to identify. Case Report A 19-year-old man was admitted to the hospital for the onset of stroke. A diagnosis of APS accompanied by IE was made after a series of examinations. We identified aortic valve vegetation as the embolic source. Although both APS and IE can induce valve vegetation, we considered IE to be the primary cause according to the infective clues. Despite treatment with ampicillin, the patient's fever persisted, and surgical aortic valve replacement was performed urgently. The patient recovered without recurrence of stroke during the 1-year follow-up. Conclusion A considerable challenge for physicians is evaluating all the signs suggestive of embolic sources in acute stroke and identifying the primary etiology when there are multiple causes. Early diagnosis and surgical intervention for bicuspid aortic valve (BAV) vegetation complicated by acute stroke may yield favorable clinical results.
Collapse
|
22
|
Vervoort D, An KR, Elbatarny M, Tam DY, Quastel A, Verma S, Connelly KA, Yanagawa B, Fremes SE. Dealing with the epidemic of endocarditis in people who inject drugs. Can J Cardiol 2022; 38:1406-1417. [PMID: 35691567 DOI: 10.1016/j.cjca.2022.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 05/18/2022] [Accepted: 06/05/2022] [Indexed: 11/19/2022] Open
Abstract
North America is facing an opioid epidemic and growing illicit drug supply, contributing to growing numbers of injection drug use-related infective endocarditis (IDU-IE). Patients with IDU-IE have high early and late mortality. Patients with IDU-IE more commonly present with right-sided IE compared to those with non-IDU-IE and a majority are a result of S. aureus. While most patients can be successfully managed with intravenous antibiotic treatment, surgery is often required in part related to high relapse rates, potential treatment biases, and more aggressive pathophysiology in some. Multidisciplinary management as endocarditis teams, including not only cardiologists and cardiac surgeons but also infectious disease specialists, drug addiction experts, social workers, neurologists and/or neurosurgeons, is essential to best manage substance use disorder and facilitate safe discharge to home and society. Structural and population-level interventions, such as harm reduction programs, are necessary to reduce IDU-IE relapse rates in the community and other IDU-related health concerns such as overdoses. In this review, we describe the pathophysiological, clinical, surgical, social, and ethical characteristics of IDU-IE and the management thereof. We present the most recent clinical guidelines for this condition and discuss existing gaps in knowledge to guide future research, practice changes, and policy interventions.
Collapse
Affiliation(s)
- Dominique Vervoort
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kevin R An
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Malak Elbatarny
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Derrick Y Tam
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Adam Quastel
- Department of Psychiatry, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Subodh Verma
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kim A Connelly
- Division of Cardiology, Department of Medicine, St Michael's Hospital, Keenan Research Centre for Biomedical Research, Toronto, Ontario, Canada
| | - Bobby Yanagawa
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Stephen E Fremes
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada; Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
| |
Collapse
|
23
|
Abstract
The management of infective endocarditis is complex and inherently requires multidisciplinary cooperation. About half of all patients diagnosed with infective endocarditis will meet the criteria to undergo cardiac surgery, which regularly takes place in urgent or emergency settings. The pathophysiology and clinical presentation of infective endocarditis make it a unique disorder within cardiac surgery that warrants a thorough understanding of specific characteristics in the perioperative period. This includes, among others, echocardiography, coagulation, bleeding management, or treatment of organ dysfunction. In this narrative review article, the authors summarize the current knowledge on infective endocarditis relevant for the clinical anesthesiologist in perioperative management of respective patients. Furthermore, the authors advocate for the anesthesiologist to become a structural member of the endocarditis team.
Collapse
|
24
|
OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6523883. [DOI: 10.1093/ejcts/ezac056] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 12/12/2021] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
|
25
|
Sahai A, Suarez WA. Reversible Cortical Blindness in Pediatric Native Valve Endocarditis. Pediatr Emerg Care 2021; 37:e1750-e1752. [PMID: 31929392 DOI: 10.1097/pec.0000000000002006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Native valve endocarditis, a rare phenomenon in children, can present with septic embolization and devastating consequences. We present a healthy child with bilateral cortical blindness due to native mitral valve endocarditis. After prompt medical and surgical therapy, he regained complete vision. Early surgical intervention resulted in the best outcome.
Collapse
Affiliation(s)
- Archit Sahai
- From the Department of Pediatrics, University of Toledo College of Medicine and Life Sciences, Toledo OH
| | | |
Collapse
|
26
|
Morishige S, Oe M, Goto T, Ishimaru T. Successful perioperative management of a case of infective endocarditis secondary to a Lemierre's syndrome variant with severe neurological manifestations. J Card Surg 2021; 36:3446-3449. [PMID: 34114258 DOI: 10.1111/jocs.15727] [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: 03/04/2021] [Revised: 04/24/2021] [Accepted: 05/15/2021] [Indexed: 11/29/2022]
Abstract
Lemierre's syndrome (LS) is characterized by septic thrombophlebitis of the internal jugular vein with septicemia and metastatic infection following an oropharyngeal infection. LS is rare but can cause infective endocarditis (IE), complicating IE management. We report a case of IE secondary to thrombophlebitis in the left vertebral vein following pharyngitis (LS variant) with distinctively severe manifestations, including metastatic infection and severe neurological impairment with multiple cerebral infarctions. A pedunculated abscess was noted on the left ventricular free wall. Despite the patient's highly impaired consciousness level (i.e., comatose state), we performed early surgery to remove the abscess after excluding LS-related brain complications. Preoperative antibiotics included clindamycin to cover LS-related anaerobic bacteria, and thrombophlebitis required postoperative anticoagulation. By managing LS as well as IE, the infection was controlled, and the neurological status normalized. This report provides insights into the perioperative management of IE secondary to LS.
Collapse
Affiliation(s)
- Shoji Morishige
- Department of Cardiovascular Surgery, Fukuoka Red Cross Hospital, Fukuoka, Japan
| | - Masahiro Oe
- Department of Cardiovascular Surgery, Fukuoka Red Cross Hospital, Fukuoka, Japan
| | - Takeyuki Goto
- Department of Infectious Disease Medicine, Fukuoka Red Cross Hospital, Fukuoka, Japan
| | - Toshiyuki Ishimaru
- Department of Infectious Disease Medicine, Fukuoka Red Cross Hospital, Fukuoka, Japan
| |
Collapse
|
27
|
Amabile A, Geirsson A. Lemierre-like syndrome and infective endocarditis: A triumph of eponyms. J Card Surg 2021; 36:3450-3451. [PMID: 34091965 DOI: 10.1111/jocs.15728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 05/31/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Andrea Amabile
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Arnar Geirsson
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
28
|
Arregle F, Martel H, Philip M, Gouriet F, Casalta JP, Riberi A, Torras O, Casalta AC, Camoin-Jau L, Lavagna F, Renard S, Ambrosi P, Lepidi H, Collart F, Hubert S, Drancourt M, Raoult D, Habib G. Infective endocarditis with neurological complications: Delaying cardiac surgery is associated with worse outcome. Arch Cardiovasc Dis 2021; 114:527-536. [PMID: 33935000 DOI: 10.1016/j.acvd.2021.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 01/23/2021] [Accepted: 01/28/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Infective endocarditis (IE) is associated with a high mortality rate, related in part to neurological complications. Studies suggest that valvular surgery should be performed early when indicated, but is often delayed by the presence of neurological complications. AIM To assess the effect of delaying surgery in patients with IE and neurological complications and to identify factors predictive of death. METHODS In a prospective, single-centre study in a referral centre for IE, all patients with IE underwent systematic screening for neurological complications. The primary outcome was 6-month death. In patients presenting with neurological complications, the prognosis according to surgical status was analysed and a Cox regression model used to identify variables predictive of death. RESULTS Between April 2014 and January 2018, 351 patients with a definite diagnosis of left-sided IE were included. Ninety-four patients (26.8%) presented with at least one neurological complication. Fifty-nine patients (17.7%) died during 6-month follow-up. Six-month mortality rates did not differ significantly between patients with and without neurological complications (P=0.60). Forty patients had a temporary surgical contraindication because of neurological complications. During the period of surgical contraindication, seven of these patients (17.5%) died, six (15.0%) presented a new embolic event, and 12 (30.0%) presented cardiac or septic deterioration. In multivariable analysis, predictive factors of death in patients presenting with neurological complications were temporary surgical contraindication (hazard ratio 7.36, 95% confidence interval 1.61-33.67; P=0.010) and presence of a mechanical prosthetic valve (hazard ratio 16.40, 95% confidence interval 2.22-121.17; P=0.006). CONCLUSIONS Patients with a temporary surgical contraindication due to neurological complications had a higher risk of death and frequent major complications while waiting for surgery. When indicated, the decision to postpone surgery in the early phase should be weighed against the risk of infectious or cardiac deterioration.
Collapse
Affiliation(s)
- Florent Arregle
- AP-HM, La Timone Hospital, Cardiology Department, 13005 Marseille, France
| | - Helene Martel
- AP-HM, La Timone Hospital, Cardiology Department, 13005 Marseille, France
| | - Mary Philip
- AP-HM, La Timone Hospital, Cardiology Department, 13005 Marseille, France
| | - Frederique Gouriet
- Aix Marseille Univ, IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, 13005 Marseille, France
| | - Jean Paul Casalta
- Aix Marseille Univ, IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, 13005 Marseille, France
| | - Alberto Riberi
- Department of Cardiac Surgery, La Timone Hospital, 13005 Marseille, France
| | - Olivier Torras
- AP-HM, La Timone Hospital, Cardiology Department, 13005 Marseille, France
| | | | - Laurence Camoin-Jau
- Aix Marseille Univ, IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, 13005 Marseille, France; Department of Hematology, La Timone Hospital, 13005 Marseille, France
| | - Flora Lavagna
- AP-HM, La Timone Hospital, Cardiology Department, 13005 Marseille, France
| | - Sebastien Renard
- AP-HM, La Timone Hospital, Cardiology Department, 13005 Marseille, France
| | - Pierre Ambrosi
- AP-HM, La Timone Hospital, Cardiology Department, 13005 Marseille, France
| | - Hubert Lepidi
- Aix Marseille Univ, IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, 13005 Marseille, France
| | - Frederic Collart
- Department of Cardiac Surgery, La Timone Hospital, 13005 Marseille, France
| | - Sandrine Hubert
- AP-HM, La Timone Hospital, Cardiology Department, 13005 Marseille, France
| | - Michel Drancourt
- Aix Marseille Univ, IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, 13005 Marseille, France
| | - Didier Raoult
- Aix Marseille Univ, IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, 13005 Marseille, France
| | - Gilbert Habib
- AP-HM, La Timone Hospital, Cardiology Department, 13005 Marseille, France; Aix Marseille Univ, IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, 13005 Marseille, France.
| |
Collapse
|
29
|
Rice CJ, Kovi S, Wisco DR. Cerebrovascular Complication and Valve Surgery in Infective Endocarditis. Semin Neurol 2021; 41:437-446. [PMID: 33851397 DOI: 10.1055/s-0041-1726327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Infective endocarditis (IE) with neurologic complications is common in patients with active IE. The most common and feared neurological complication of left-sided IE is cerebrovascular, from septic emboli causing ischemic stroke, intracranial hemorrhage (ICH), or an infectious intracranial aneurysm with or without rupture. In patients with cerebrovascular complications, valve replacement surgery is often delayed for concern of further neurological worsening. However, in circumstances when an indication for valve surgery to treat IE is present, the benefits of early surgical treatment may outweigh the potential neurologic deterioration. Furthermore, valve surgery has been associated with lower in-hospital mortality than medical therapy with intravenous antibiotics alone. Early valve surgery can be performed within 7 days of transient ischemic attack or asymptomatic stroke when medically indicated. Timing of valve surgery for IE after symptomatic medium or large symptomatic ischemic stroke or ICH remains challenging, and current data in the literature are conflicting about the risks and benefits. A delay of 2 to 4 weeks from the time of the cerebrovascular event is often recommended, balancing the risks and benefits of surgery. The range of timing of valve surgery varies depending on the clinical scenario, and is best determined by a multidisciplinary decision between cardiothoracic surgeons, cardiologists, infectious disease experts, and vascular neurologists in an experienced referral center.
Collapse
Affiliation(s)
- Cory J Rice
- Erlanger Medical Center, University of Tennessee-Chattanooga College of Medicine, Chattanooga, Tennessee
| | - Shivakrishna Kovi
- Department of Neurology, Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Dolora R Wisco
- Department of Neurology, Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
30
|
Hoshino S, Kido K, Maeda K, Ichiba T, Takatori M. Delayed Obstructive Hydrocephalus After Cardiac Surgery With Cardiopulmonary Bypass in a Patient With Cerebellar Infarction: A Case Report. A A Pract 2021; 15:e01439. [PMID: 33783405 DOI: 10.1213/xaa.0000000000001439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Obstructive hydrocephalus caused by brainstem compression is a life-threatening complication and usually occurs within 6 days, with peak on day 3 after onset of cerebellar infarction. We present a case of obstructive hydrocephalus that developed on day 8 in a patient with cerebellar infarction. A 39-year-old man with cerebellar infarction caused by myocardial infarction-related intraventricular thrombus underwent left ventricular thrombectomy under cardiopulmonary bypass. He was lucid postoperatively, but his consciousness was diminished on day 8 because of obstructive hydrocephalus. Cerebral edema due to cardiopulmonary bypass may contribute to delayed onset of obstructive hydrocephalus, especially in patients with large-sized cerebellar infarction.
Collapse
Affiliation(s)
- Shun Hoshino
- From the Departments of Anesthesiology and Intensive Care Medicine and
| | - Koji Kido
- From the Departments of Anesthesiology and Intensive Care Medicine and
| | - Keisuke Maeda
- Emergency Medicine, Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Toshihisa Ichiba
- Emergency Medicine, Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Makoto Takatori
- From the Departments of Anesthesiology and Intensive Care Medicine and
| |
Collapse
|
31
|
Injection Drug Use Endocarditis: An Inner-City Hospital Experience. CJC Open 2021; 3:896-903. [PMID: 34401696 PMCID: PMC8347875 DOI: 10.1016/j.cjco.2021.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/25/2021] [Indexed: 12/13/2022] Open
Abstract
Background There has been a rise in the incidence of injection drug use and associated infective endocarditis. Methods The clinical outcomes of 39 patients admitted with injection drug use-associated infective endocarditis were collected with a mean follow-up of 14 months. The outcomes were compared for patients treated medically with those undergoing surgical intervention. Re sults: The mean age was 39 ± 11 years; 54% were female. Thirty-two patients (82%) had native and 7 (18%) prosthetic infective endocarditis. The tricuspid valve was affected in 17 patients (43%), the mitral in 10 (26%), the aortic in 4 (10%), and multiple valves in 8 (20%). Sixteen (41%) patients underwent surgery, and 23 (59%) were treated with medical therapy. The indications for surgery included heart failure, systemic emboli, recurrent infection, and vegetation size ≥10 mm. Patients undergoing surgery had a higher rate of paravalvular abscess (25% vs 0%, P = 0.02), valve perforation (37% vs 11%, P = 0.04), and mitral valve involvement (44% vs 13%, P = 0.06), whereas medically treated patients had higher tricuspid valve involvement (61% vs 19%, P = 0.02). During follow-up, 26% of medical and 31% of surgical cohort patients died (P = 0.7). Mortality was highest (54%) among those who continued medical management despite an indication for surgery. Univariate predictors of mortality were age (odds ratio [OR] 1.09, 95% confidence interval [CI]: 1.01-1.17; P = 0.02), heart failure (OR 6.9; 95% CI: 1.24-37.49; P = 0.02), septicemia (OR 4.40; 95% CI:0.99-19.54; P = 0.05), and shock (OR 10.8; 95% CI: 1.68-69.92; P = 0.01). Conclusions Despite contemporary therapy, patients with injection drug use-associated infective endocarditis remain at high risk of complications and poor clinical outcomes. These findings highlight the need for developing new care pathways and a team approach for effective management.
Collapse
|
32
|
An KR, Luc JGY, Tam DY, Dagher O, Eikelboom R, Bierer J, Cartier A, Vo TX, Vaillancourt O, Forgie K, Elbatarny M, Gao SW, Whitlock R, Lamba W, Arora RC, Adams C, Yanagawa B. Infective Endocarditis Secondary to Injection Drug Use: A Survey of Canadian Cardiac Surgeons. Ann Thorac Surg 2021; 112:1460-1467. [PMID: 33358887 DOI: 10.1016/j.athoracsur.2020.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/10/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Injection drug use-associated infective endocarditis (IDU-IE) is a growing epidemic. The objective of this survey was to identify the beliefs and practice patterns of Canadian cardiac surgeons regarding surgical management of IDU-IE. METHODS A 30-question survey was developed by a working group and distributed to all practicing adult cardiac surgeons in Canada. Data were analyzed using descriptive statistics. RESULTS Of 146 surgeons, 94 completed the survey (64%). Half of surgeons (49%) would be less likely to operate on patients with IE if associated with IDU. In the case of prosthetic valve IE owing to continued IDU, 36% were willing to reoperate once and 14% were willing to reoperate twice or more. Most surgeons required commitments from patients before surgery (73%), and most referred patients to addiction services (81%). Some surgeons would offer a Ross procedure (10%) or homograft (8%) for aortic valve IE, and 47% would consider temporary mechanical circulatory support. Whereas only 17% of surgeons worked at an institution with an endocarditis team, 71% agreed that there was a need for one at each institution. Most surgeons supported the development of IDU-IE-specific guidelines (80%). CONCLUSIONS Practice patterns and surgical management of IDU-IE vary considerably across Canada. Areas of clinical unmet needs include the development of a formal addiction services referral protocol for patients, the development of an interdisciplinary endocarditis team, as well as the creation of IDU-IE clinical practice guidelines.
Collapse
Affiliation(s)
- Kevin R An
- Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Canada
| | - Jessica G Y Luc
- Division of Cardiovascular Surgery, University of British Columbia, Vancouver, Canada
| | - Derrick Y Tam
- Division of Cardiovascular Surgery, University of British Columbia, Vancouver, Canada
| | - Olina Dagher
- Division of Cardiac Surgery, University of Calgary, Calgary, Canada
| | - Rachel Eikelboom
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Joel Bierer
- Division of Cardiac Surgery, Dalhousie University, Halifax, Canada
| | | | - Thin X Vo
- Division of Cardiac Surgery, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Canada
| | | | - Keir Forgie
- Division of Cardiac Surgery, University of Alberta, Edmonton, Canada
| | - Malak Elbatarny
- Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Canada
| | | | - Richard Whitlock
- Division of Cardiac Surgery, McMaster University, Hamilton, Canada
| | - Wiplove Lamba
- Division of Psychiatry, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Rakesh C Arora
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Corey Adams
- Division of Cardiac Surgery, University of Calgary, Calgary, Canada
| | - Bobby Yanagawa
- Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Canada.
| |
Collapse
|
33
|
Chakraborty T, Rabinstein A, Wijdicks E. Neurologic complications of infective endocarditis. HANDBOOK OF CLINICAL NEUROLOGY 2021; 177:125-134. [PMID: 33632430 DOI: 10.1016/b978-0-12-819814-8.00008-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Infective endocarditis (IE) is an infection primarily affecting the endocardium of heart valves that can embolize systemically and to the brain. Neurologic manifestations include strokes, intracerebral hemorrhages, mycotic aneurysms, meningitis, cerebral abscesses, and infections of the spine. Neurologic involvement is associated with worse mortality, though it does not always portend a poor functional prognosis. Neuroimaging is indicated in patients who have neurologic symptoms, including cerebral vessel imaging in patients who have subarachnoid hemorrhage. In the case of acute ischemic stroke (IS), IV thrombolysis is contraindicated but endovascular thrombectomy may be a consideration. Neurologic findings understandably raise concern about valve surgery when indicated due to the risk of hemorrhage with perioperative anticoagulation. However, most neurologic complications do not preclude valve surgery and valve surgery may in fact be indispensable in some cases to prevent further neurologic problems. Management decisions in patients with IE and neurologic complications should therefore be multidisciplinary with a major contribution from the neurologist.
Collapse
Affiliation(s)
- Tia Chakraborty
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | | | - Eelco Wijdicks
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| |
Collapse
|
34
|
Bonaros N, Czerny M, Pfausler B, Müller S, Bartel T, Thielmann M, Shehada SE, Folliguet T, Obadia JF, Holfeld J, Lorusso R, Parolari A, Müller L, Grimm M, Ruttmann-Ulmer E. Infective endocarditis and neurologic events: indications and timing for surgical interventions. Eur Heart J Suppl 2020; 22:M19-M25. [PMID: 33664636 PMCID: PMC7916418 DOI: 10.1093/eurheartj/suaa167] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A therapeutic dilemma arises when infective endocarditis (IE) is complicated by a neurologic event. Postponement of surgery up to 4 weeks is recommended by the guidelines, however, this negatively impacts outcomes in many patients with an urgent indication for surgery due to uncontrolled infection, disease progression, or haemodynamic deterioration. The current literature is ambiguous regarding the safety of cardiopulmonary bypass in patients with recent neurologic injury. Nevertheless, most publications demonstrate a lower risk for secondary haemorrhagic conversion of uncomplicated ischaemic lesions than the risk for recurrent embolism under antibiotic treatment. Here, we discuss the current literature regarding neurologic stroke complicating IE with an indication for surgery.
Collapse
Affiliation(s)
- Nikolaos Bonaros
- Department of Cardiac Surgery, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Martin Czerny
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Bettina Pfausler
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Silvana Müller
- Department of Internal Medicine III, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Bartel
- Department of Cardiology Mediclinic City, Hospital Dubai, Dubai, United Arab Emirates
| | - Matthias Thielmann
- Clinic for Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre Essen, Essen, Germany
| | - Sharaf-Eldin Shehada
- Clinic for Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre Essen, Essen, Germany
| | - Thierry Folliguet
- Department of Cardiac Surgery and Transplantation, Henry Mondor Hospital, Paris, France
| | - Jean-Francois Obadia
- Department of Cardiac Surgery and Transplantation, Louis Pradel Hospital, Lyon, France
| | - Johannes Holfeld
- Department of Cardiac Surgery, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Roberto Lorusso
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maaastricht, The Netherlands
| | | | - Ludwig Müller
- Department of Cardiac Surgery, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Michael Grimm
- Department of Cardiac Surgery, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Elfriede Ruttmann-Ulmer
- Department of Cardiac Surgery, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| |
Collapse
|
35
|
Faluk MA, Vuu S, Kathi K, Abdelmaseih R, Cignoni C, Tarasiuk-Rusek A, Prashad R, Osian O. Challenges in Managing Acute Myocardial Infarction Associated With Infective Endocarditis: A Case Report. J Investig Med High Impact Case Rep 2020; 8:2324709620960001. [PMID: 32935586 PMCID: PMC7498957 DOI: 10.1177/2324709620960001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Acute myocardial infarction (AMI) is a rare but recognized and potentially serious
complication of infective endocarditis (IE). This case describes the challenges
surrounding the management of AMI in the setting of septic coronary embolism, brain,
spleen, and kidney infarcts due to septic emboli from native mitral valve IE.
Collapse
Affiliation(s)
- Mohammed Ali Faluk
- University of Central Florida, Orlando, FL, USA.,Ocala Regional Medical Center, Ocala, FL, USA
| | - Steven Vuu
- University of Central Florida, Orlando, FL, USA.,Ocala Regional Medical Center, Ocala, FL, USA
| | - Kiran Kathi
- University of Central Florida, Orlando, FL, USA.,Ocala Regional Medical Center, Ocala, FL, USA
| | - Ramy Abdelmaseih
- University of Central Florida, Orlando, FL, USA.,Ocala Regional Medical Center, Ocala, FL, USA
| | - Christian Cignoni
- University of Central Florida, Orlando, FL, USA.,Ocala Regional Medical Center, Ocala, FL, USA
| | - Aneta Tarasiuk-Rusek
- University of Central Florida, Orlando, FL, USA.,Ocala Regional Medical Center, Ocala, FL, USA
| | - Rakesh Prashad
- University of Central Florida, Orlando, FL, USA.,Ocala Regional Medical Center, Ocala, FL, USA
| | - Omeni Osian
- University of Central Florida, Orlando, FL, USA.,Ocala Regional Medical Center, Ocala, FL, USA
| |
Collapse
|
36
|
Abstract
PURPOSE OF REVIEW Stroke continues to be a leading cause of debility in the world. Infections have been associated with stroke, but are not considered as directly causal, and so they are not often included in the traditional stroke workup and management. They are especially important in patients with stroke of undetermined etiology, and in certain patient populations, such as young patients without traditional risk factors, and immunocompromised patients. RECENT FINDINGS There has been strong evidence for infectious conditions, such as endocarditis, and pathogens, such as varicella zoster in stroke causation, and more supportive evidence is surfacing in recent years of several organisms increasing the stroke risk or being directly causal in stroke. The evidence also seems to be pointing to the role of inflammation in increasing the risk of stroke via accelerated atherosclerosis, vasculitis and vasculopathy. SUMMARY Infectious causes should be considered in the differential and work up of stroke in certain patient populations and appropriate treatments need to be initiated to minimize adverse stroke-related outcomes.
Collapse
|
37
|
Distinct Subpopulations of Intravalvular Methicillin-Resistant Staphylococcus aureus with Variable Susceptibility to Daptomycin in Tricuspid Valve Endocarditis. Antimicrob Agents Chemother 2020; 64:AAC.01593-19. [PMID: 31932377 DOI: 10.1128/aac.01593-19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 01/01/2020] [Indexed: 11/20/2022] Open
Abstract
We present a case of endocarditis wherein organisms cultured from different valve leaflets yielded different daptomycin susceptibilities from each other and from organisms obtained from peripheral blood culture. Genomic analyses showed mutations in mprF, purR, and agrA Pharmacokinetic simulations showed consistent activity of daptomycin plus beta-lactam against all subpopulations. This represents an opportunity to understand S. aureus evolution and fitness in vivo on daptomycin therapy and the role of beta-lactams to prevent the selection of daptomycin-resistant subpopulations.
Collapse
|
38
|
Kowatari R, Suzuki Y, Daitoku K, Fukuda I. Cryptococcal infective endocarditis in a child with acute lymphocytic leukaemia. Interact Cardiovasc Thorac Surg 2019; 28:642-644. [PMID: 30376048 DOI: 10.1093/icvts/ivy291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/28/2018] [Accepted: 09/16/2018] [Indexed: 11/13/2022] Open
Abstract
A 4-year-old boy with acute lymphocytic leukaemia presented with left hemiplegia during chemotherapy. Computed tomography revealed cerebral infarction, and an echocardiogram showed vegetation in the right and left ventricles. Despite antifungal therapy, he experienced another stroke; and 9 days after the first stroke, he underwent total extirpation of the vegetative nodules and fragile vegetation. The postoperative course was unremarkable with no recurrence of infective endocarditis. Although a bacterial culture of the vegetation could not identify the presence of any organism, a pathological specimen examination revealed Cryptococcus with a round and mucinous capsule.
Collapse
Affiliation(s)
- Ryosuke Kowatari
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Yasuyuki Suzuki
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Kazuyuki Daitoku
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Ikuo Fukuda
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
| |
Collapse
|
39
|
Venn RA, Ning M, Vlahakes GJ, Wasfy JH. Surgical timing in infective endocarditis complicated by intracranial hemorrhage. Am Heart J 2019; 216:102-112. [PMID: 31422194 DOI: 10.1016/j.ahj.2019.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 07/13/2019] [Indexed: 12/24/2022]
Abstract
Given the growing incidence of infective endocarditis (IE), understanding the risks and benefits of valvular surgery is critical. This decision is particularly complex for the 1 in 10 cases complicated by intracranial hemorrhage (ICH). While guideline recommendations currently favor early surgery in general, delayed intervention of at least 4 weeks is still recommended for patients with ICH. To date, there are no randomized controlled trials that inform management of patients with an indication for surgery but concomitant ICH, and even reported observational data are rare. This paper reviews the current literature on timing of surgery with a specific focus on cases of ICH. It emphasizes a growing body of literature challenging the current paradigm that surgery within 4 weeks is associated with neurologic deterioration and high mortality rates by demonstrating favorable outcomes for patients with pre-operative ICH who undergo early valvular surgery. Based on these data, we propose a practical management algorithm to facilitate decisions on surgical timing in these complicated cases. Since more rigorous evidence may never be available, clinicians should make patient-specific surgical timing decisions that attempt to balance the competing risks of neurologic versus cardiac complications.
Collapse
Affiliation(s)
- Rachael A Venn
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - MingMing Ning
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Gus J Vlahakes
- Cardiac Surgery Division, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Jason H Wasfy
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
| |
Collapse
|
40
|
Aranda-Michel E, Yousef S, Sultan I, Kilic A. Septic coronary embolism in a deceptive case of presumed isolated tricuspid valve endocarditis. J Card Surg 2019; 34:1130-1132. [PMID: 31374581 DOI: 10.1111/jocs.14198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A 46-year-old female presented with native tricuspid valve endocarditis complicated by a stroke with a hemorrhagic component. There was no evidence of intracardiac shunt nor left-sided valve involvement. Delayed surgery was planned to allow neurologic recovery, however, the patient developed an ST-elevation myocardial infarction and cardiac arrest from an occluded right posterior ventricular branch of the right coronary artery from a septic embolism. Repeat imaging demonstrated new aortic valve vegetation involving the right coronary cusp. This case highlights a unique sequence of events in a patient initially presenting with presumed isolated tricuspid valve vegetation.
Collapse
Affiliation(s)
- Edgar Aranda-Michel
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sarah Yousef
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ibrahim Sultan
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Arman Kilic
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| |
Collapse
|
41
|
Ruch Y, Mazzucotelli JP, Lefebvre F, Martin A, Lefebvre N, Douiri N, Riegel P, Hoang Minh T, Petit-Eisenmann H, Hansmann Y, Argemi X. Impact of Setting up an "Endocarditis Team" on the Management of Infective Endocarditis. Open Forum Infect Dis 2019; 6:ofz308. [PMID: 31660397 PMCID: PMC6735925 DOI: 10.1093/ofid/ofz308] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 06/25/2019] [Indexed: 02/06/2023] Open
Abstract
Background Infective endocarditis (IE) remains a severe disease with a high mortality rate. Therefore, guidelines encourage the setup of a multidisciplinary group in reference centers. The present study evaluated the impact of this "Endocarditis Team" (ET). Methods We conducted a monocentric observational study at Strasbourg University Hospital, Strasbourg, France, between 2012 and 2017. The primary end point was in-hospital mortality. Secondary end points were 6-month and 1-year mortality, surgery rate, time to surgical procedure, duration of effective antibiotic therapy, length of in-hospital stay, and sequelae. We also assessed predictors of in-hospital mortality. Results We analyzed 391 episodes of IE. In the post-ET period, there was a nonsignificant decrease in in-hospital mortality (20.3% vs 14.7%, respectively; P = .27) and sequelae, along with a significant reduction in time to surgery (16.4 vs 10.3 days, respectively; P = .049), duration of antibiotic therapy (55.2 vs 47.2 days, respectively; P < .001), and length of in-hospital stay (40.6 vs 31.9 days, respectively; P < .01). In a multivariate analysis, the post-ET period was positively associated with survival (odds ratio, 0.45; 95% confidence interval, 0.20-0.96; P = .048). Conclusions This multidisciplinary approach exerted a positive impact on the management of IE and should be considered in all hospitals managing IE.
Collapse
Affiliation(s)
- Yvon Ruch
- Department of Infectious Disease, Strasbourg University Hospital, Strasbourg, France
| | | | - François Lefebvre
- Department of Biostatistics, Strasbourg University Hospital, Strasbourg, France
| | - Aurélie Martin
- Department of Infectious Disease, Strasbourg University Hospital, Strasbourg, France
| | - Nicolas Lefebvre
- Department of Infectious Disease, Strasbourg University Hospital, Strasbourg, France
| | - Nawal Douiri
- Department of Infectious Disease, Strasbourg University Hospital, Strasbourg, France
| | - Philippe Riegel
- Laboratory of Bacteriology, Strasbourg University Hospital, Strasbourg, France
| | - Tam Hoang Minh
- Department of Cardiovascular Surgery, Strasbourg University Hospital, Strasbourg, France
| | | | - Yves Hansmann
- Department of Infectious Disease, Strasbourg University Hospital, Strasbourg, France
| | - Xavier Argemi
- Department of Infectious Disease, Strasbourg University Hospital, Strasbourg, France
| |
Collapse
|
42
|
Tam DY, Yanagawa B, Verma S, Ruel M, Fremes SE, Mazine A, Adams S, Friedrich JO. Early vs Late Surgery for Patients With Endocarditis and Neurological Injury: A Systematic Review and Meta-analysis. Can J Cardiol 2019; 34:1185-1199. [PMID: 30170674 DOI: 10.1016/j.cjca.2018.05.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/08/2018] [Accepted: 05/08/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Surgical timing in infective endocarditis (IE) with preoperative neurological events remains controversial. The relevant society guidelines are each on the basis of a small number of observational studies. This meta-analysis was designed to search the available literature broadly and assess the weight of available evidence as comprehensively as possible. METHODS We searched MEDLINE and EMBASE to April 2018 for studies that compared mortality or neurological exacerbation in early vs late surgery for IE complicated by neurological events. Random effects meta-analysis was performed. RESULTS Twenty-seven observational studies (25 unadjusted, n = 879; 2 adjusted, n = 451) met inclusion criteria. Using early and late thresholds defined in each study (7 or 14 days), early surgery in ischemic or hemorrhagic stroke was associated with elevated perioperative mortality vs late surgery (pooled relative risk [RR], 1.74; 95% confidence interval, 1.34-2.25; P < 0.0001; I2 = 0%) and greater neurological exacerbation (RR, 2.09; 95% confidence interval, 1.32-3.32; P = 0.002; I2 = 33%). In subgroup analysis, for ischemic stroke, early surgery before 7 vs before 14 days exhibited similar perioperative mortality and neurological exacerbation. For hemorrhagic stroke, performing surgery before 21 vs before 28 days showed trends toward perioperative mortality (RR, 1.77 vs 0.63, interaction P = 0.14) and neurological (RR, 2.02 vs RR, 0.44; interaction P = 0.11) exacerbation. There was no difference in long-term mortality but reporting was sparse. Early surgery was often performed for clinical deterioration, negatively biasing outcomes. CONCLUSIONS Available observational data support delaying surgery by 7-14 days if possible in IE complicated by ischemic stroke and > 21 days in hemorrhagic stroke to decrease perioperative mortality and neurological exacerbation rates. Randomized trials are needed for definitive guidance.
Collapse
Affiliation(s)
- Derrick Y Tam
- Division of Cardiac Surgery, Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Bobby Yanagawa
- Division of Cardiac Surgery, Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
| | - Subodh Verma
- Division of Cardiac Surgery, Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Marc Ruel
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Stephen E Fremes
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Amine Mazine
- Division of Cardiac Surgery, Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Seana Adams
- Division of Cardiac Surgery, Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jan O Friedrich
- Critical Care and Medicine Departments, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
43
|
Chakraborty T, Scharf E, DeSimone D, El Rafei A, Brinjikji W, Baddour LM, Wilson W, Steckelberg JM, Fugate JE, Wijdicks EFM, Rabinstein AA. Variable Significance of Brain MRI Findings in Infective Endocarditis and Its Effect on Surgical Decisions. Mayo Clin Proc 2019; 94:1024-1032. [PMID: 30922693 DOI: 10.1016/j.mayocp.2018.09.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 08/20/2018] [Accepted: 09/18/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To determine how brain magnetic resonance imaging (MRI) findings impact clinical outcomes in patients with infective endocarditis (IE) and to propose a management algorithm for patients with neurologic symptoms who are candidates for valve surgery (VS). PATIENTS AND METHODS Data from our center were retrospectively reviewed for patients hospitalized with IE between January 1, 2007, and December 31, 2014. Outcomes were postoperative intracerebral hemorrhage (ICH), 6-month mortality, and functional outcome at last follow-up as described by the modified Rankin Scale (mRS) score. Good outcome was defined as an mRS score of 2 or less. RESULTS A total of 361 patients with IE were identified, including 127 patients (35%) who had MRI. One hundred twenty-six of 361 patients (35%) had neurologic symptoms, which prompted MRI in 79 of 127 patients (62%); 74 of 79 (94%) had acute or subacute MRI abnormalities. One patient with subarachnoid and multifocal ICH on MRI developed postoperative ICH. Patients with VS despite MRI abnormalities had lower 6-month mortality (odds ratio [OR], 0.17; 95% CI, 0.06-0.48; P<.001) and better functional outcome (OR, 4.43; 95% CI, 1.51-13.00; P=.005). Irrespective of VS, lobar or posterior fossa ICH on MRI was associated with 6-month mortality (OR, 3.58; 95% CI, 1.22-10.50; P=.02) and territorial ischemic stroke was inversely associated with good mRS (OR, 0.29; 95% CI, 0.13-0.66; P=.002). In neurologically asymptomatic patients who had VS, MRI findings did not impact 6-month mortality or functional outcomes. CONCLUSION Magnetic resonance imaging detects a large number of abnormalities in patients with IE. Preoperative lobar hematoma and large territorial stroke determine outcome irrespective of VS. When indicated, VS increases the odds of a good outcome despite MRI abnormalities.
Collapse
Affiliation(s)
| | | | - Daniel DeSimone
- Department of Infectious Diseases, Mayo Clinic, Rochester, MN
| | | | | | - Larry M Baddour
- Department of Infectious Diseases, Mayo Clinic, Rochester, MN; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Walter Wilson
- Department of Infectious Diseases, Mayo Clinic, Rochester, MN
| | | | | | | | | |
Collapse
|
44
|
Ryu AJ, Geske JB. 63-Year-Old Man With Fever, Chills, and Myalgias. Mayo Clin Proc 2019; 94:882-886. [PMID: 30935707 DOI: 10.1016/j.mayocp.2018.08.045] [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: 06/28/2018] [Revised: 07/28/2018] [Accepted: 08/02/2018] [Indexed: 11/24/2022]
Affiliation(s)
- Alexander J Ryu
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Jeffrey B Geske
- Advisor to residents and Consultant in Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
| |
Collapse
|
45
|
Yanagawa B, Elbatarny M, Verma S, Hill S, Mazine A, Puskas JD, Friedrich JO. Surgical Management of Tricuspid Valve Infective Endocarditis: A Systematic Review and Meta-Analysis. Ann Thorac Surg 2018; 106:708-714. [PMID: 29750928 DOI: 10.1016/j.athoracsur.2018.04.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 03/31/2018] [Accepted: 04/02/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND This meta-analysis compares the early and late outcomes of valve repair versus replacement, the primary surgical strategies for tricuspid valve infective endocarditis (IE). METHODS We searched MEDLINE and EMBASE databases until 2016 for studies comparing tricuspid valve repair and replacement. RESULTS The main outcomes were mortality, recurrent IE, and need for reoperation. There were 12 unmatched retrospective observational studies with 1,165 patients (median follow-up 3.8 years, interquartile range: 2.1 to 5.0). The most common indications for surgery were septic pulmonary embolism, left-sided IE, right-side heart failure, and persistent bacteremia. Median repair proportion was 59% and replacement was 41% among studies. The primary repair strategies are vegetectomy, De Vega procedure, annuloplasty ring, bicuspidization, and leaflet patch augmentation. Of valve replacements, 83% were bioprosthetic and 17% mechanical prostheses. There were no differences in perioperative mortality between tricuspid valve repair versus replacement (relative risk [RR] 0.62, 95% confidence interval [CI]: 0.26 to 1.46, p = 0.3). Long-term all-cause mortality was not different (RR 0.61, 95% CI: 0.22 to 1.72, p = 0.4). Valve repair was associated with lower recurrent IE (RR 0.17, 95% CI: 0.05 to 0.57, p = 0.004) and need for reoperation (RR 0.26, 95% CI: 0.07 to 0.92, p = 0.04) but a trend toward greater risk of moderate to severe tricuspid regurgitation (RR 4.14, 95% CI: 0.80 to 21.34, p = 0.09). Furthermore, tricuspid valve repair is associated with lower need for permanent pacemaker (RR 0.20, 95% CI: 0.11 to 0.35, p < 0.001). CONCLUSIONS Tricuspid valve repair and replacement offer similar long-term survival. Valve repair may offer greater freedom from recurrent IE and reoperation as well as freedom from pacemaker and should be the preferred approach for patients with tricuspid valve IE.
Collapse
Affiliation(s)
- Bobby Yanagawa
- Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
| | - Malak Elbatarny
- Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Subodh Verma
- Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Samantha Hill
- Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Amine Mazine
- Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - John D Puskas
- Department of Cardiothoracic Surgery, Mount Sinai Hospital, New York, New York
| | - Jan O Friedrich
- Department of Critical Care and Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
46
|
Oswald RF, Müller-Busch HC. [A challenging decision-making-process pro or con surgical heart valve replacement in a case of long-term non-adherence : A case report]. Wien Med Wochenschr 2018; 168:199-203. [PMID: 29450784 DOI: 10.1007/s10354-018-0625-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 01/25/2018] [Indexed: 11/29/2022]
Abstract
A young, still multimorbid woman aquires infectious endocarditis. Anamnestically severe non-adherence concerning medical advice is reported. Complete cure may only be achieved by performing surgical heart valve replacement, which implies lifelong scrupulous oral anticoagulation postoperatively. Discussion evolves within medical staff, whether surgery should be indicated or not.
Collapse
Affiliation(s)
- René Florian Oswald
- Abteilung für Anästhesiologie und Intensivmedizin, LKH Weststeiermark, Radlpass Straße 29, 8530, Deutschlandsberg, Österreich.
| | | |
Collapse
|
47
|
Ghoreishi M, Foster N, Pasrija C, Shah A, Watkins AC, Evans CF, Maghami S, Quinn R, Wehman B, Taylor BS, Dawood MY, Griffith BP, Gammie JS. Early Operation in Patients With Mitral Valve Infective Endocarditis and Acute Stroke Is Safe. Ann Thorac Surg 2017; 105:69-75. [PMID: 29132700 DOI: 10.1016/j.athoracsur.2017.06.069] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 06/26/2017] [Accepted: 06/27/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND To determine if preoperative embolic stroke is associated with an increased risk of postoperative stroke among patients undergoing early operation for mitral valve (MV) infective endocarditis (IE), we compared outcomes among patients presenting with and without acute stroke. METHODS From 2003 to 2015, 243 consecutive patients underwent surgery for active MV IE. Patients were categorized into 2 groups: 72% (174 of 243 patients) with no preoperative acute stroke (clinical, radiographic or both) and 28% (69 of 243 patients) with stroke. Both preoperative and postoperative strokes were confirmed in all patients with brain computed tomography or magnetic resonance imaging and comprehensive examination by a neurologist. RESULTS Among patients presenting with stroke, 33% (23 of 69 patients) were asymptomatic and had only positive imaging findings. The median time from admission to operation was 5 days. The overall rate of new postoperative stroke was 4% (10 of 243 patients). The rate of postoperative stroke was not different between the 2 groups: 4% (7 of 174 patients) among patients with no preoperative stroke and 4% (3 of 69 patients) with stroke (p = 0.9). One patient developed a hemorrhagic conversion of an acute infarct. Operative mortality was 7% (13 of 174 patients) among patients with no preoperative stroke and 7% (5 of 69 patients) among patients with stroke (p = 0.9). CONCLUSIONS MV surgery for IE and acute stroke can be performed early with a low risk of postoperative neurologic complications. When indicated, surgical intervention for MV IE complicated by acute stroke should not be delayed.
Collapse
Affiliation(s)
- Mehrdad Ghoreishi
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Nate Foster
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Chetan Pasrija
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Aakash Shah
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - A Claire Watkins
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Charlie F Evans
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Sam Maghami
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Rachael Quinn
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Brody Wehman
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Bradley S Taylor
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Murtaza Y Dawood
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Bartley P Griffith
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - James S Gammie
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
| |
Collapse
|
48
|
Guaricci AI, Musci RL, Santis DD, Argentiero D, Sgarra L, Losito C, Marangelli V, Nacci F, Zanna D, Favale S. An atypical pseudoaneurysm as complication of prosthetic aortic-valve endocarditis. Future Cardiol 2017; 13:533-537. [PMID: 29034726 DOI: 10.2217/fca-2017-0032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Endocarditis of a prosthetic heart valve is a life-threatening condition that is associated with high morbidity and mortality. Perivalvular extension in infective endocarditis includes complications such as periannular or intramyocardial abscesses, pseudoaneurysms and fistulae. The incidence of perivalvular extension ranges from 10 to 30% in native valve endocarditis and 30 to 55% in prosthetic aortic-valve endocarditis. Herein, we describe a case of a 66-year-old man who presented endocarditis of a prosthetic aortic valve complicated by infective pseudoaneurysm with localization next to the right coronary sinus of Valsalva. Moreover, we underscore the importance of the diagnostic imaging tools options and surgical timing.
Collapse
Affiliation(s)
- Andrea I Guaricci
- Department of Emergency & Organ Transplantation, Institute of Cardiovascular Disease, University Hospital 'Policlinico' of Bari, Bari, Italy
| | - Rita L Musci
- Department of Emergency & Organ Transplantation, Institute of Cardiovascular Disease, University Hospital 'Policlinico' of Bari, Bari, Italy
| | - Delia De Santis
- Department of Emergency & Organ Transplantation, Institute of Cardiovascular Disease, University Hospital 'Policlinico' of Bari, Bari, Italy
| | - Donatella Argentiero
- Department of Emergency & Organ Transplantation, Institute of Cardiovascular Disease, University Hospital 'Policlinico' of Bari, Bari, Italy
| | - Luca Sgarra
- Department of Emergency & Organ Transplantation, Institute of Cardiovascular Disease, University Hospital 'Policlinico' of Bari, Bari, Italy
| | - Concetta Losito
- Department of Cardiac Surgery, Department of Emergency & Organ Transplantation, University Hospital 'Policlinico' of Bari, Bari, Italy
| | - Vito Marangelli
- Department of Emergency & Organ Transplantation, Institute of Cardiovascular Disease, University Hospital 'Policlinico' of Bari, Bari, Italy
| | - Frida Nacci
- Department of Emergency & Organ Transplantation, Institute of Cardiovascular Disease, University Hospital 'Policlinico' of Bari, Bari, Italy
| | - Domenico Zanna
- Department of Emergency & Organ Transplantation, Institute of Cardiovascular Disease, University Hospital 'Policlinico' of Bari, Bari, Italy
| | - Stefano Favale
- Department of Emergency & Organ Transplantation, Institute of Cardiovascular Disease, University Hospital 'Policlinico' of Bari, Bari, Italy
| |
Collapse
|
49
|
Cantier M, Mazighi M, Klein I, Desilles JP, Wolff M, Timsit JF, Sonneville R. Neurologic Complications of Infective Endocarditis: Recent Findings. Curr Infect Dis Rep 2017; 19:41. [PMID: 28929294 DOI: 10.1007/s11908-017-0593-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE OF REVIEW The purpose of this paper is to provide recent insights in management of neurologic complications of left-sided infective endocarditis (IE). RECENT FINDINGS Cerebral lesions observed in IE patients are thought to involve synergistic pathophysiological mechanisms including thromboembolism, sepsis, meningitis, and small-vessel cerebral vasculitis. Brain MRI represents a major tool for the detection of asymptomatic events occurring in the majority of patients. The latter can impact therapeutic decisions and prognosis, especially when cardiac surgery is indicated. In patients presenting with neurologic complications, surgery could be safely performed earlier than previously thought. Symptomatic cerebral ischemic or hemorrhagic events occur in 20-55% of IE patients, whereas asymptomatic events are detected in 60-80% of patients undergoing systematic brain MRI. Management of such patients requires an experienced multidisciplinary team. Recent studies suggest that early cardiac surgery, when indicated, can be performed safely in patients with cerebral ischemic events. Other important issues include the appropriate use of anti-infective and anti-thrombotic agents, and endovascular treatment for mycotic aneurysms. Altered mental status at IE onset, which is associated with brain injury, is a major determinant of short-term outcome.
Collapse
Affiliation(s)
- Marie Cantier
- Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, Assistance Publique - Hôpitaux de Paris, 46 rue Henri Huchard, 75018, Paris, France. .,INSERM U1148, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
| | - Mikael Mazighi
- INSERM U1148, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,Department of Neurology, Lariboisière University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Isabelle Klein
- Imaging Department, Clinique Alleray Labrouste, Paris, France
| | - J P Desilles
- INSERM U1148, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Michel Wolff
- Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, Assistance Publique - Hôpitaux de Paris, 46 rue Henri Huchard, 75018, Paris, France
| | - J F Timsit
- Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, Assistance Publique - Hôpitaux de Paris, 46 rue Henri Huchard, 75018, Paris, France
| | - Romain Sonneville
- Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, Assistance Publique - Hôpitaux de Paris, 46 rue Henri Huchard, 75018, Paris, France. .,INSERM U1148, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
| |
Collapse
|
50
|
|