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Manokaran P, Krishnasamy S, Aman RRABR, Teoh VWY, Loch A. Aortic root pseudoaneurysm: a case report and literature review. Indian J Thorac Cardiovasc Surg 2024; 40:68-77. [PMID: 38125320 PMCID: PMC10728390 DOI: 10.1007/s12055-023-01580-x] [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: 02/02/2023] [Revised: 07/17/2023] [Accepted: 07/17/2023] [Indexed: 12/23/2023] Open
Abstract
Pseudoaneurysms of the aortic root are rare. A case of prosthetic aortic valve infection progressing from a confined intramural abscess to a ruptured abscess communicating with the aorta and forming a large pseudoaneurysm is described. Additionally, data from all cases and case series, published between 2000 and 2021, was analyzed. A PUBMED search for the keywords "aortic root mycotic aneurysm," "aortic root abscess AND infective endocarditis," and "aortic root mycotic aneurysm AND infective endocarditis" yielded 152 publications (with 157 cases described): Aortic pseudoaneurysm is more common in males (80.9%, n = 127). Mean age is 51 years (4 months-84 years). The most common symptom is fever (68.5%, n = 102). Mean time until diagnosis is 27.2 days. Embolic complications are present in 17.8% (n = 28) at diagnosis. Most cases are due to valvular infections (n = 72 cases, 45.9%). Prior cardiac surgery is documented in 49.0% (n = 77). The mean time interval for developing aortic root abscess following heart surgery is 32.2 months. 22.3% (n = 35) are immunocompromised. Aetiological agents were Staphylococcus sp. (34.1%, n = 47) and Streptococcus sp. (23.2%, n = 32). Mean antimicrobial therapy lasts 58.5 days. Outcome with surgery is superior to medical treatment: overall inpatient mortality 18.5% (n = 27); with surgery 12.2% (n = 15 out of 123 patients), with only medical management 47.8% (n = 11 out of 23 patients). In conclusion, aortic root pseudoaneurysm occurs most commonly in middle-aged male patients. History of prior aortic procedures is commonly present. Correct diagnosis hinges on detailed history, transoesophageal echocardiography, and computed tomography (CT) aorta. Surgery is the preferred therapeutic option. Supplementary Information The online version contains supplementary material available at 10.1007/s12055-023-01580-x.
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Affiliation(s)
| | - Sivakumar Krishnasamy
- Department of Surgery/Cardiothoracic, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | | | | | - Alexander Loch
- Department of Medicine/Cardiology, University Malaya Medical Centre, Kuala Lumpur, Malaysia
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Kothapalli PR, Wyler von Ballmoos MC. Editorial: Suffering the pain of discipline or the pain of regret: Early surgery for infectious endocarditis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 58:23-24. [PMID: 37981506 DOI: 10.1016/j.carrev.2023.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 10/30/2023] [Indexed: 11/21/2023]
Affiliation(s)
- Priya R Kothapalli
- Department of Cardiology, Texas Health Harris Methodist Hospital, Fort Worth, TX, United States of America
| | - Moritz C Wyler von Ballmoos
- Department of Cardiovascular & Thoracic Surgery, Texas Health Harris Methodist Hospital, Fort Worth, TX, United States of America.
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Pallotto C, Bolla C, Penpa S, Genga G, Sarda C, Svizzeretto E, Tommasi A, Stolaj E, Salvaderi A, Piceni G, Maconi A, Chichino G, Francisci D. Adherence to 2015 ESC Guidelines for the Treatment of Infective Endocarditis: A Retrospective Multicentre Study (LEIOT Study). Antibiotics (Basel) 2023; 12:antibiotics12040705. [PMID: 37107067 PMCID: PMC10135336 DOI: 10.3390/antibiotics12040705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/24/2023] [Accepted: 03/30/2023] [Indexed: 04/07/2023] Open
Abstract
Background: Infective endocarditis (IE) is still a severe disease with elevated morbidity and mortality. Nevertheless, the last European guidelines (GL) date back to 2015, and a recent survey described a diffuse suboptimal adherence to their recommendations. Here, we described a real-life scenario about adherence to IE treatment GL. Methods: This was a retrospective, multicentric, case–control study. All the cases of IE admitted to our wards from 2016 to 2020 were enrolled. Patients were divided into two groups, according to the non-adherence (group A, cases) or adherence (group B, controls) to 2015 ESC guidelines. Only targeted treatments were considered. Groups were compared for demographic, clinical, microbiological, and laboratory data and outcome. As a post hoc analysis, we analysed the characteristics of deviations from the guidelines and how these deviations affected mortality. Results: A total of 246 patients were enrolled, with 128 (52%) in group A and 118 (48%) in group B. Groups were homogeneous except for aetiologies: staphylococcal and blood-culture-negative IE were more frequent in group A, while streptococcal and enterococcal IE were more frequent in group B (p < 0.001). In-hospital mortality was comparable in the two groups. The most frequent causes of deviations from the guidelines were use of daptomycin, in addition to standard treatments and the missing administration of rifampin or gentamycin. Conclusions: Adherence to 2015 ESC guidelines was limited but it did not affect mortality.
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Affiliation(s)
- Carlo Pallotto
- Infectious Diseases Clinic, Santa Maria della Misericordia Hospital, University of Perugia, 06100 Perugia, Italy
| | - Cesare Bolla
- Infectious Diseases, Department of Internal Medicine, Azienda Ospedaliera SS, Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Serena Penpa
- Research Training Innovation Infrastructure, Research and Innovation Department, Azienda Ospedaliera SS, Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Giovanni Genga
- Infectious Diseases Clinic, Santa Maria della Misericordia Hospital, University of Perugia, 06100 Perugia, Italy
| | - Cristina Sarda
- Infectious Diseases, Department of Internal Medicine, Azienda Ospedaliera SS, Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Elisabetta Svizzeretto
- Infectious Diseases Clinic, Santa Maria della Misericordia Hospital, University of Perugia, 06100 Perugia, Italy
| | - Andrea Tommasi
- Infectious Diseases Clinic, Santa Maria della Misericordia Hospital, University of Perugia, 06100 Perugia, Italy
| | - Elisa Stolaj
- Infectious Diseases Clinic, Santa Maria della Misericordia Hospital, University of Perugia, 06100 Perugia, Italy
| | - Andrea Salvaderi
- Infectious Diseases Clinic, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Giorgia Piceni
- Research Training Innovation Infrastructure, Research and Innovation Department, Azienda Ospedaliera SS, Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Antonio Maconi
- Research Training Innovation Infrastructure, Research and Innovation Department, Azienda Ospedaliera SS, Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Guido Chichino
- Infectious Diseases, Department of Internal Medicine, Azienda Ospedaliera SS, Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Daniela Francisci
- Infectious Diseases Clinic, Santa Maria della Misericordia Hospital, University of Perugia, 06100 Perugia, Italy
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Infective Endocarditis in High-Income Countries. Metabolites 2022; 12:metabo12080682. [PMID: 35893249 PMCID: PMC9329978 DOI: 10.3390/metabo12080682] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 01/27/2023] Open
Abstract
Infective endocarditis remains an illness that carries a significant burden to healthcare resources. In recent times, there has been a shift from Streptococcus sp. to Staphylococcus sp. as the primary organism of interest. This has significant consequences, given the virulence of Staphylococcus and its propensity to form a biofilm, rendering non-surgical therapy ineffective. In addition, antibiotic resistance has affected treatment of this organism. The cohorts at most risk for Staphylococcal endocarditis are elderly patients with multiple comorbidities. The innovation of transcatheter technologies alongside other cardiac interventions such as implantable devices has contributed to the increased risk attributable to this cohort. We examined the pathophysiology of infective endocarditis carefully. Inter alia, the determinants of Staphylococcus aureus virulence, interaction with host immunity, as well as the discovery and emergence of a potential vaccine, were investigated. Furthermore, the potential role of prophylactic antibiotics during dental procedures was also evaluated. As rates of transcatheter device implantation increase, endocarditis is expected to increase, especially in this high-risk group. A high level of suspicion is needed alongside early initiation of therapy and referral to the heart team to improve outcomes.
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Schnieder M, Chebbok M, Didié M, Wolf F, Badr M, Allam I, Bähr M, Hasenfuß G, Liman J, Schroeter MR. Comparing the diagnostic value of Echocardiography In Stroke (CEIS) - results of a prospective observatory cohort study. BMC Neurol 2021; 21:118. [PMID: 33731046 PMCID: PMC7968180 DOI: 10.1186/s12883-021-02136-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/25/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Echocardiography is one of the main diagnostic tools for the diagnostic workup of stroke and is already well integrated into the clinical workup. However, the value of transthoracic vs. transesophageal echocardiography (TTE/TEE) in stroke patients is still a matter of debate. Aim of this study was to characterize relevant findings of TTE and TEE in the management of stroke patients and to correlate them with subsequent clinical decisions and therapies. METHODS We evaluated n = 107 patients admitted with an ischemic stroke or transient ischemic attack to our stroke unit of our university medical center. They underwent TTE and TEE examination by different blinded investigators. RESULTS Major cardiac risk factors were found in 8 of 98 (8.2%) patients and minor cardiac risk factors for stroke were found in 108 cases. We found a change in therapeutic regime after TTE or TEE in 22 (22.5%) cases, in 5 (5%) cases TEE leads to the change of therapeutic regime, in 4 (4%) TTE and in 13 cases (13.3%) TTE and TEE lead to the same change in therapeutic regime. The major therapy change was the indication to close a patent foramen ovale (PFO) in 9 (9.2%) patients with TTE and in 10 (10.2%) patients with TEE (p = 1.000). CONCLUSION Major finding with clinical impact on therapy change is the detection of PFO. But for the detection of PFO, TTE is non inferior to TEE, implicating that TTE serves as a good screening tool for detection of PFO, especially in young age patients. TRIAL REGISTRATION The trial was registered and approved prior to inclusion by our local ethics committee (1/3/17).
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Affiliation(s)
- Marlena Schnieder
- Department for Cardiology & Pneumology/Heart Center, University Medical Center Göttingen, Robert-Koch Straße 40, 37075, Göttingen, Germany.
| | - Mohammed Chebbok
- Department for Neurology, University Medical Center Göttingen, Robert-Koch Straße 40, 37075, Göttingen, Germany
| | - Michael Didié
- Department for Neurology, University Medical Center Göttingen, Robert-Koch Straße 40, 37075, Göttingen, Germany
| | - Frieder Wolf
- Department for Neurology, University Medical Center Göttingen, Robert-Koch Straße 40, 37075, Göttingen, Germany
| | - Mostafa Badr
- Department for Cardiology & Pneumology/Heart Center, University Medical Center Göttingen, Robert-Koch Straße 40, 37075, Göttingen, Germany
| | - Ibrahim Allam
- Department for Cardiology & Pneumology/Heart Center, University Medical Center Göttingen, Robert-Koch Straße 40, 37075, Göttingen, Germany
| | - Mathias Bähr
- Department for Cardiology & Pneumology/Heart Center, University Medical Center Göttingen, Robert-Koch Straße 40, 37075, Göttingen, Germany
| | - Gerd Hasenfuß
- Department for Neurology, University Medical Center Göttingen, Robert-Koch Straße 40, 37075, Göttingen, Germany
| | - Jan Liman
- Department for Cardiology & Pneumology/Heart Center, University Medical Center Göttingen, Robert-Koch Straße 40, 37075, Göttingen, Germany
| | - Marco Robin Schroeter
- Department for Neurology, University Medical Center Göttingen, Robert-Koch Straße 40, 37075, Göttingen, Germany
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