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Countouris ME, Marino AL, Raymond M, Hauspurg A, Berlacher KL. Infective Endocarditis in Pregnancy: A Contemporary Cohort. Am J Perinatol 2024; 41:e230-e235. [PMID: 35709725 PMCID: PMC9943787 DOI: 10.1055/a-1877-5763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Pregnancy-related infective endocarditis (IE) caries a high risk of morbidity and mortality. With increasing intravenous drug abuse (IVDA) amid the opioid epidemic, the risk factor profile may be shifting. In this case series, we aimed to describe risk factors and outcomes for peripartum IE in a contemporary cohort. STUDY DESIGN We identified patients with IE diagnosed during pregnancy or up to 6 weeks' postpartum from 2015 through 2018 at a single tertiary care center. We abstracted detailed medical history and clinical outcome measures from the electronic medical record. The diagnosis of IE was supported by the modified Duke Criteria. RESULTS Nine patients had peripartum IE: eight (89%) with a history of IVDA, one with an indwelling central venous catheter (11%), and one with prior IE (11%). None had preexisting congenital or valvular heart disease. Six (67%) had comorbid hepatitis C. Eight cases (89%) had gram-positive cocci with vegetations involving the tricuspid valve (56%) and both mitral and tricuspid valves (22%). Major complications included shock (33%), mechanical ventilation (44%), septic emboli (67%), and noncardiac abscesses (33%). Two patients underwent valve surgery, and there were two cases of postpartum maternal mortality (22%), one from septic shock and one from intracerebral hemorrhage. While four patients (44%) delivered preterm (average gestational age 35 weeks), most delivered vaginally (89%) with only one requiring an emergent caesarean section. There was no fetal mortality, although three newborns (43%) required admission to the neonatal intensive care unit. Two patients were initiated on medication-assisted treatment for opioid use disorder. Consultants included infectious disease, cardiology, cardiac surgery, maternal-fetal medicine, and psychiatry. CONCLUSION These findings confirm that IVDA is a growing risk factor for pregnancy-related IE. Peripartum IE carries a high risk of complications, including maternal mortality, and warrants management with a multidisciplinary care team at a tertiary center. KEY POINTS · Intravenous drug use was the most common risk factor for IE in pregnancy.. · IE in pregnancy carries a high morbidity and mortality with complications including septic emboli, septic shock, and need for mechanical ventilation.. · A multidisciplinary team approach can assure the best possible maternal and fetal outcomes..
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Affiliation(s)
- Malamo E Countouris
- University of Pittsburgh Medical Center, Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Amy L Marino
- University of Pittsburgh Medical Center, Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Megan Raymond
- Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Alisse Hauspurg
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Pittsburgh Medical Center University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Kathryn L Berlacher
- University of Pittsburgh Medical Center, Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
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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: 259] [Impact Index Per Article: 259.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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3
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Onofrei VA, Adam CA, Marcu DTM, Crisan Dabija R, Ceasovschih A, Constantin M, Grigorescu ED, Petroaie AD, Mitu F. Infective Endocarditis during Pregnancy-Keep It Safe and Simple! MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050939. [PMID: 37241171 DOI: 10.3390/medicina59050939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023]
Abstract
The diagnosis of infective endocarditis (IE) during pregnancy is accompanied by a poor prognosis for both mother and fetus in the absence of prompt management by multidisciplinary teams. We searched the electronic databases of PubMed, MEDLINE and EMBASE for clinical studies addressing the management of infective endocarditis during pregnancy, with the aim of realizing a literature review ranging from risk factors to diagnostic investigations to optimal therapeutic management for mother and fetus alike. The presence of previous cardiovascular pathologies such as rheumatic heart disease, congenital heart disease, prosthetic valves, hemodialysis, intravenous catheters or immunosuppression are the main risk factors predisposing patients to IE during pregnancy. The identification of modern risk factors such as intracardiac devices and intravenous drug administration as well as genetic diagnostic methods such as cell-free deoxyribonucleic acid (DNA) next-generation sequencing require that these cases be addressed in multidisciplinary teams. Guiding treatment to eradicate infection and protect the fetus simultaneously creates challenges for cardiologists and gynecologists alike.
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Affiliation(s)
- Viviana Aursulesei Onofrei
- Department of Medical Specialties I, II, III and Preventive Medicine and Interdisciplinary, "Grigore T. Popa" University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- "St. Spiridon" Clinical Emergency Hospital, Independence Boulevard No. 1, 700111 Iasi, Romania
| | - Cristina Andreea Adam
- Department of Medical Specialties I, II, III and Preventive Medicine and Interdisciplinary, "Grigore T. Popa" University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- Cardiovascular Rehabilitation Clinic, Clinical Rehabilitation Hospital, Pantelimon Halipa Street No. 14, 700661 Iasi, Romania
| | - Dragos Traian Marius Marcu
- Department of Medical Specialties I, II, III and Preventive Medicine and Interdisciplinary, "Grigore T. Popa" University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- Clinical Hospital of Pneumophthisiology Iași, Doctor Iosif Cihac Street No. 30, 700115 Iasi, Romania
| | - Radu Crisan Dabija
- Department of Medical Specialties I, II, III and Preventive Medicine and Interdisciplinary, "Grigore T. Popa" University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- Clinical Hospital of Pneumophthisiology Iași, Doctor Iosif Cihac Street No. 30, 700115 Iasi, Romania
| | - Alexandr Ceasovschih
- Department of Medical Specialties I, II, III and Preventive Medicine and Interdisciplinary, "Grigore T. Popa" University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- "St. Spiridon" Clinical Emergency Hospital, Independence Boulevard No. 1, 700111 Iasi, Romania
| | - Mihai Constantin
- Department of Medical Specialties I, II, III and Preventive Medicine and Interdisciplinary, "Grigore T. Popa" University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- "St. Spiridon" Clinical Emergency Hospital, Independence Boulevard No. 1, 700111 Iasi, Romania
| | - Elena-Daniela Grigorescu
- Department of Medical Specialties I, II, III and Preventive Medicine and Interdisciplinary, "Grigore T. Popa" University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
| | - Antoneta Dacia Petroaie
- Department of Medical Specialties I, II, III and Preventive Medicine and Interdisciplinary, "Grigore T. Popa" University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
| | - Florin Mitu
- Department of Medical Specialties I, II, III and Preventive Medicine and Interdisciplinary, "Grigore T. Popa" University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- Cardiovascular Rehabilitation Clinic, Clinical Rehabilitation Hospital, Pantelimon Halipa Street No. 14, 700661 Iasi, Romania
- Academy of Medical Sciences, Ion C. Brătianu Boulevard No. 1, 030167 Bucharest, Romania
- Academy of Romanian Scientists, Professor Dr. Doc. Dimitrie Mangeron Boulevard No. 433, 700050 Iasi, Romania
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4
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Yoon CW, Bushnell CD. Stroke in Women: A Review Focused on Epidemiology, Risk Factors, and Outcomes. J Stroke 2023; 25:2-15. [PMID: 36746378 PMCID: PMC9911842 DOI: 10.5853/jos.2022.03468] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 01/04/2023] [Indexed: 02/04/2023] Open
Abstract
Stroke is a particularly important issue for women. Women account for over half of all persons who experienced a stroke. The lifetime risk of stroke is higher in women than in men. In addition, women have worse stroke outcomes than men. Several risk factors have a higher association with stroke in women than in men, and women-specific risk factors that men do not have should be considered. This focused review highlights recent findings in stroke epidemiology, risk factors, and outcomes in women.
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Affiliation(s)
- Cindy W. Yoon
- Department of Neurology, Inha University School of Medicine, Incheon, Korea
| | - Cheryl D. Bushnell
- Department of Neurology, Wake Forest University School of Medicine, Winston Salem, NC, USA,Correspondence: Cheryl D. Bushnell Department of Neurology, Wake Forest University School of Medicine, Medical Center Blvd, Winston Salem, NC 27157, USA Tel: +1-336-716-2983
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5
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Zaleski KL, Blazey MH, Carabuena JM, Economy KE, Valente AM, Nasr VG. Perioperative Anesthetic Management of the Pregnant Patient With Congenital Heart Disease Undergoing Cardiac Intervention: A Systematic Review. J Cardiothorac Vasc Anesth 2022; 36:4483-4495. [PMID: 36195521 DOI: 10.1053/j.jvca.2022.09.001] [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] [Received: 06/13/2022] [Revised: 08/29/2022] [Accepted: 09/01/2022] [Indexed: 11/11/2022]
Abstract
Maternal congenital heart disease is increasingly prevalent, and has been associated with a significantly increased risk of maternal, obstetric, and neonatal complications. For patients with CHD who require cardiac interventions during pregnancy, there is little evidence-based guidance with regard to optimal perioperative management. The periprocedural management of pregnant patients with congenital heart disease requires extensive planning and a multidisciplinary teams-based approach. Anesthesia providers must not only be facile in the management of adult congenital heart disease, but cognizant of the normal, but significant, physiologic changes of pregnancy.
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Affiliation(s)
- Katherine L Zaleski
- Department of Anesthesiology, Critical Care, and Pain Medicine-Boston Children's Hospital, Harvard Medical School, Boston, MA
| | | | - Jean M Carabuena
- Department of Anesthesiology, Perioperative and Pain Medicine-Brigham and Women's Hospital, Harvard Medical School, Boston MA
| | - Katherine E Economy
- Division of Maternal-Fetal Medicine, Brigham, and Women's Hospital, Harvard Medical School, Boston, MA
| | - Anne M Valente
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Viviane G Nasr
- Department of Anesthesiology, Critical Care, and Pain Medicine-Boston Children's Hospital, Harvard Medical School, Boston, MA.
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6
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Katsafanas C, Bushnell C. Pregnancy and stroke risk in women. Neurobiol Dis 2022; 169:105735. [PMID: 35477033 DOI: 10.1016/j.nbd.2022.105735] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 04/05/2022] [Accepted: 04/13/2022] [Indexed: 10/18/2022] Open
Abstract
Stroke associated with pregnancy and post-partum occurs in about 30 per 100,000 deliveries, and includes subtypes of ischemic and hemorrhagic stroke as well as cerebral venous sinus thrombosis (CVST). There are a wide variety of underlying causes and risk factors, some that are common to both pregnant and non-pregnant women, and others that are unique to pregnancy. Although some of the strokes that occur may be a direct result of the pregnancy itself, such as hypertensive disorders of pregnancy, others could be anticipated or prevented by understanding the risk factors. These may include the presence of pre-pregnancy clotting disorders, aneurysms or arteriovenous malformations, hypertension, diabetes, or advanced maternal age. Treatment of stroke during pregnancy is based on the current recommendations for non-pregnant stroke patients, assuming the benefit of these treatments is likely higher than the risks. These decisions must be made with the appropriate specialists in stroke and endovascular treatment, as well as high-risk obstetrician/gynecologists, and most importantly, patient and family preferences.
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Affiliation(s)
- Constance Katsafanas
- University of Florida at Jacksonville, Department of Neurology, United States of America
| | - Cheryl Bushnell
- Wake Forest School of Medicine, Department of Neurology, United States of America.
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7
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Peripartum native valve endocarditis without underlying risk factors. Indian J Thorac Cardiovasc Surg 2021; 37:565-568. [PMID: 34511765 DOI: 10.1007/s12055-021-01143-y] [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: 10/31/2020] [Revised: 12/31/2020] [Accepted: 01/06/2021] [Indexed: 10/22/2022] Open
Abstract
Infective endocarditis (IE) complicating pregnancy though rare is associated with adverse maternal and fetal outcome. Due to its rarity and varied presentation, literature on IE complicating pregnancy is sparse. We report a case of IE complicating pregnancy caused by methicillin-resistant Staphylococcus aureus (MRSA) in a healthy pregnant lady without any known risk factors. This is the first documented case of IE complicating pregnancy without any underlying risk factors from the Indian subcontinent. This article also briefly outlines the current recommendation regarding management of infective endocarditis caused by MRSA.
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8
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Rebechi MT, Heil EL, Luethy PM, Schmalzle SA. Streptococcus pyogenes Infective Endocarditis-Association With Injection Drug Use: Case Series and Review of the Literature. Open Forum Infect Dis 2021; 8:ofab240. [PMID: 34262985 PMCID: PMC8274460 DOI: 10.1093/ofid/ofab240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/05/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Streptococcus pyogenes, or Group A Streptococcus (GAS), is not considered a typical cause of infective endocarditis (IE), but has anecdotally been observed in unexpectedly high rates in people who inject drugs (PWID) at our institution. METHODS All cases of possible or definite GAS IE per Modified Duke Criteria in adults at an academic hospital between 11/15/2015 and 11/15/2020 were identified. Medical records were reviewed for demographics, comorbidities, treatment, and outcomes related to GAS IE. The literature on cases of GAS IE was reviewed. RESULTS Eighteen cases of probable (11) or definite (7) GAS IE were identified; the mean age was 38 years, and the population was predominantly female (56%) and Caucasian (67%), which is inconsistent with local population demographics. Sixteen cases were in people who inject drugs (PWID; 89%); 14 were also homeless, 6 also had HIV (33%), and 2 were also pregnant. Antibiotic regimens were variable due to polymicrobial bacteremia (39%). One patient underwent surgical valve replacement. Four patients (22%) died due to complications of infection. The literature review revealed 42 adult cases of GAS IE, only 17 of which were in PWID (24%). CONCLUSIONS The 16 cases of possible and definite GAS IE in PWID over a 5-year period in a single institution reported nearly doubles the number of cases in PWID from all previous reports. This suggests a potential increase in GAS IE particularly in PWID and PWH, which warrants further epidemiologic investigation.
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Affiliation(s)
| | - Emily L Heil
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Paul M Luethy
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Sarah A Schmalzle
- University of Maryland School of Medicine, Baltimore, Maryland, USA
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA
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9
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Vale H, Rabalais JG, Lane JK, Mason CL, Calimaran AL, Castillo D. Emergent cardiopulmonary bypass during cesarean delivery. A case report. Clin Case Rep 2021; 9:CCR33067. [PMID: 34026117 PMCID: PMC8136444 DOI: 10.1002/ccr3.3067] [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: 08/26/2019] [Revised: 05/02/2020] [Accepted: 05/21/2020] [Indexed: 11/05/2022] Open
Abstract
Successful management of Cesarean Delivery complicated by emergent CPB and AVR requires meticulous multidisciplinary planning. This case also represents the volatility that can arise from severe aortic regurgitation during pregnancy.
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Affiliation(s)
- Henrique Vale
- University of Mississippi Medical CenterJacksonMississippiUSA
| | | | - Jenna K. Lane
- University of Mississippi Medical CenterJacksonMississippiUSA
| | - Chawla L. Mason
- University of Mississippi Medical CenterJacksonMississippiUSA
| | | | - Daniel Castillo
- University of Mississippi Medical CenterJacksonMississippiUSA
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10
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Libera R, Macaulay K, Donato AA, Green J, McCarty C. Tricuspid valve endocarditis in pregnancy: a case report and review of the literature. J Community Hosp Intern Med Perspect 2021; 11:99-102. [PMID: 33552428 PMCID: PMC7850377 DOI: 10.1080/20009666.2020.1839236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Infective endocarditis (IE) is a rare complication in pregnancy that is associated with significant morbidity and mortality to both mother and fetus. We present a case of a 27-year-old female at 22-weeks gestation with a history of intravenous drug abuse (IVDA) who developed methicillin sensitive Staphylococcus aureus tricuspid valve endocarditis with persistent bacteremia and septic emboli necessitating tricuspid valve extirpation. Four days later, worsening decompensated heart failure required cesarean section at 23w5d. Although the patient's volume status and dyspnea improved significantly, fetal demise occurred 9 days after operative delivery.
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Affiliation(s)
- Robert Libera
- Internal Medicine, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Kyle Macaulay
- Department of Internal Medicine, Reading Hospital, Reading, PA, USA
| | - Anthony A Donato
- Department of Internal Medicine, Reading Hospital, Reading, PA, USA
| | - Jared Green
- Department of Cardiology, Reading Hospital, Reading, PA, USA
| | - Christine McCarty
- Internal Medicine, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA.,Department of Internal Medicine, Reading Hospital, Reading, PA, USA.,Department of Cardiology, Reading Hospital, Reading, PA, USA
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11
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Sarumathi D, Anitha G, R D, Thilak C R, Sastry AS. A Case Report of Cardiobacterium hominis Endocarditis in a Pregnant Woman. Cureus 2020; 12:e9827. [PMID: 32953336 PMCID: PMC7495949 DOI: 10.7759/cureus.9827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Infective endocarditis (IE) is an infrequent endovascular disease, which can result in significant mortality and morbidity. Staphylococcus aureus and viridans streptococci remain the most common etiological agent. Cardiobacterium hominis, a member of the HACEK (Haemophilus species, Aggregatibacter species, Cardiobacterium hominis, Eikenella corrodens, and Kingella species) group of fastidious gram-negative bacillus, is a part of normal upper respiratory flora and a rare cause implicated in IE. Cases of Cardiobacterium hominis endocarditis are being increasingly reported in last few years due to advancement in automated blood culture system such as BacT/ALERT Virtuo® and identification system such as MALDI-TOF MS (matrix-assisted laser desorption/ionization time-of-flight mass spectrometry). We herein report a first case of Cardiobacterium hominis endocarditis in a pregnant woman at 20 weeks of gestation. Following spontaneous abortion and evacuation of the fetus, appropriate surgical intervention under heparinized condition and pathogen-directed medical intervention was initiated in this patient. This case report highlights the importance of appropriate antimicrobial therapy, which augments earlier resolution of the disease.
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Affiliation(s)
- D Sarumathi
- Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - G Anitha
- Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Deepashree R
- Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Rajeev Thilak C
- Cardiothoracic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Apurba S Sastry
- Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
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12
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Lin D, Mullan CW, Deshmukh U, Bahtiyar MO, Hosier H, Lipkind H, Abdel-Razeq S, Ranjan S, Lancaster G, Pietras C. Drug use associated tricuspid valve infective endocarditis in pregnancy. J Card Surg 2020; 35:2392-2395. [PMID: 32720414 DOI: 10.1111/jocs.14888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 06/03/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIM We report a case of intravenous drug use associated tricuspid valve endocarditis in a 28-year-old pregnant female at 26-week gestation. METHODS Patient management required a multidisciplinary collaboration between cardiac surgery, obstetrics and gynecology, and neonatal critical care. RESULTS Despite appropriate intravenous antibiotics, the patient developed life-threatening complications and underwent planned cesarean delivery at 28 weeks 6 days gestation followed by interval tricuspid valve replacement 1 week later. CONCLUSIONS Both the patient and her infant were successfully managed through the perioperative period.
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Affiliation(s)
- Dishen Lin
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Clancy W Mullan
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Uma Deshmukh
- Department of Obstetrics, Gynecology, and Reproductive Science, Yale School of Medicine, New Haven, Connecticut
| | - Mert Ozan Bahtiyar
- Department of Obstetrics, Gynecology, and Reproductive Science, Yale School of Medicine, New Haven, Connecticut
| | - Hillary Hosier
- Department of Obstetrics, Gynecology, and Reproductive Science, Yale School of Medicine, New Haven, Connecticut
| | - Heather Lipkind
- Department of Obstetrics, Gynecology, and Reproductive Science, Yale School of Medicine, New Haven, Connecticut
| | - Sonya Abdel-Razeq
- Department of Obstetrics, Gynecology, and Reproductive Science, Yale School of Medicine, New Haven, Connecticut
| | - Saurabh Ranjan
- Division of Cardiology, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Gilead Lancaster
- Division of Cardiology, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Colleen Pietras
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
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Patel C, Akhtar H, Gupta S, Harky A. Pregnancy and cardiac interventions: What are the optimal management options? J Card Surg 2020; 35:1589-1596. [PMID: 32484993 DOI: 10.1111/jocs.14637] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cardiac disease is the leading cause of maternal mortality in the United Kingdom. Major causes of cardiac death in pregnant women include cardiomyopathies, myocardial infarction, ischemic heart disease, and aortic dissection. Uncorrected congenital heart disease and women who have had corrective or palliative surgery may have complicated pregnancies as well. Some women with significant cardiac disease are unable to meet the increased physiological demands of pregnancy. Of these, those who do not respond to medical treatment may require surgical correction such as coronary artery bypass grafting. The risk of cardiac operations for pregnant women is similar to that for nonpregnant women but the fetal mortality rate remains high. Contributing factors to high fetal mortality rates include timing, urgency of operation, and the fetal/fetoplacental response to cardiopulmonary bypass. The aim of this review is to summarize current evidence in utilizing the different management approaches of cardiac issues during pregnancy.
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Affiliation(s)
- Chandni Patel
- Department of Medicine, St George's University of London, London, UK
| | - Hubba Akhtar
- Department of Medicine, St George's University of London, London, UK
| | - Shubhi Gupta
- Department of Medicine, University of Liverpool, Liverpool, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
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