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Harris WM, Sinha S, Caputo M, Angelini GD, Vohra HA. Surgical outcomes and optimal approach to treatment of aortic valve endocarditis with aortic root abscess - systematic review and meta-analysis. Perfusion 2024; 39:256-265. [PMID: 36314050 PMCID: PMC10900848 DOI: 10.1177/02676591221137484] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Data on the postoperative outcomes for patients with infective endocarditis complicated by an aortic root abscess is sparse due to the condition's low incidence and high mortality rates. This systematic review and meta-analysis aims to evaluate existing data on the impact of aortic root abscesses on the postoperative outcomes and to inform optimal surgical approach. METHODS The online databases MEDLINE, EMBASE and Cochrane library were searched from 1990 to 2022 for studies comparing cohorts of surgically managed infective endocarditis patients with and without an aortic root abscess. Data was extracted by two independent investigators and aggregated in a random-effects model. Risk of bias was assessed using an adapted version of the Newcastle-Ottawa scale. RESULTS Six clinical studies were included in the meta-analysis (n 1982). The abscess group was associated with increased in-hospital mortality (OR 1.74 95%: CI 1.18-2.56) and late mortality (HR 1.27 95% CI:1.03-1.58). The reoperation meta-analysis was complicated by high rates of heterogeneity (I2 = 59%) and found no significant differences in reoperation between abscess and no abscess groups (HR=1.48: 95% CI:0.92-2.40). Post-hoc scatter graph showed a strong linear relationship (r 0.998), suggesting hospitals with higher rates of aortic root replacement achieve lower rates of reoperation for aortic root abscess patients compared with patch reconstruction. CONCLUSIONS The presence of an aortic root abscess in aortic valve endocarditis is associated with elevated early and late mortality despite modern standards of care. Additionally, aortic root replacement should be considered to have a favourable postoperative profile for use in this context.
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Affiliation(s)
| | - Shubhra Sinha
- Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Massimo Caputo
- Bristol Heart Institute, University of Bristol, Bristol, UK
| | | | - Hunaid A Vohra
- Bristol Heart Institute, University of Bristol, Bristol, UK
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2
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Elderia A, Wallau AM, Bennour W, Gerfer S, Gaisendrees C, Krasivskyi I, Djordjevic I, Wahlers T, Weber C. Impact of Aortic Root Abscess on Surgical Outcomes of Infective Endocarditis. Life (Basel) 2024; 14:92. [PMID: 38255707 PMCID: PMC10820780 DOI: 10.3390/life14010092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/02/2024] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
Locally destructive infective endocarditis (IE) of the aortic valve complicated by abscess formation in the aortic root may seriously affect patients' outcomes. Surgical repair of such conditions is often challenging. This is a single-center observational analysis of consecutive patients treated surgically for IE between 2009 and 2019. We divided the cohort into two groups considering the presence of an aortic root abscess and compared the characteristics and postoperative outcomes of patients accordingly. Moreover, we examined three different procedures performed in abscess patients regarding operative data and postoperative results: an isolated surgical aortic valve replacement (AVR), AVR with patch reconstruction of the aortic root (AVR + RR) or the Bentall procedure. The whole cohort comprised 665 patients, including 140 (21.0%) patients with an aortic root abscess and 525 (78.9%) as the control group. The abscess group of patients received either AVR (66.4%), AVR + RR (17.8%), or the Bentall procedure (15.7%). The mean age in the whole cohort was 62.1 ± 14.8. The mean EuroSCORE II was 8.0 ± 3.5 in the abscess group and 8.4 ± 3.7 in the control group (p = 0.259). The 30-day and 1-year mortality rates were 19.6% vs. 11.3% (p = 0.009) and 40.1% vs. 29.6% (p = 0.016) in the abscess compared to the control group. The multivariable regression analysis did not reveal aortic root abscess as an independent predictor of mortality. Rather, age > 60 correlated with 30-day mortality and infection with Streptococcus spp. correlated with 1-year mortality. In the analysis according to the performed procedures, KM estimates exhibited comparable long-term survival (log-rank p = 0.325). IE recurrence was noticed in 12.3% of patients after AVR, 26.7% after AVR + RR and none after Bentall (p = 0.069). We concluded that patients with an aortic root abscess suffer worse short and long-term outcomes compared to other IE patients. The post-procedural survival among ARA patients did not significantly vary based on the procedures performed.
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Affiliation(s)
- Ahmed Elderia
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, 50937 Köln, Germany (C.W.)
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3
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Vöhringer L, Bongers MN, Helms F, Popov AF. Incidental Finding of Subannular Perfused Aortic Root Abscess. Diagnostics (Basel) 2023; 14:19. [PMID: 38201328 PMCID: PMC10802896 DOI: 10.3390/diagnostics14010019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/05/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
An 83-year-old female presented with aortic valve stenosis requiring surgery, which was diagnosed with a transthoracic echocardiography three years ago. However, the patient declined the surgery at that time due to personal reasons. Three years later she presented again with signs of dizziness and weakness and progression of the aortic valve stenosis. Cardiac catheterization and a computed tomography scan were performed before the planned surgery. Surprisingly, a huge subannular perfused abscess hole around the aortic root companying a pericardial effusion was revealed. The patient underwent an urgent aortic root replacement with a tissue valve and an aortic ascending replacement without any complications. Intraoperative inspection confirmed an active aortic root and valve endocarditis.
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Affiliation(s)
- Luise Vöhringer
- Department of Cardiothoracic and Vascular Surgery, Eberhard Karls University, 72074 Tuebingen, Germany;
- Department of Cardiac Surgery, University Hospital Basel, 4031 Basel, Switzerland
| | - Malte Niklas Bongers
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, 72074 Tuebingen, Germany;
| | - Florian Helms
- Division for Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany;
| | - Aron Frederik Popov
- Department of Cardiothoracic and Vascular Surgery, Eberhard Karls University, 72074 Tuebingen, Germany;
- Division for Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany;
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Alassiri AK, Alshair FM, Fatani MA, Baghaffar AH. Aortic root abscess and Brucella endocarditis in a patient with mechanical aortic valve prosthesis: a case report. J Surg Case Rep 2023; 2023:rjad299. [PMID: 37332666 PMCID: PMC10271217 DOI: 10.1093/jscr/rjad299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 05/06/2023] [Indexed: 06/20/2023] Open
Abstract
Rare but potentially fatal, brucellosis prosthetic valve endocarditis is a complication of brucellosis caused by Brucella species. The symptoms of brucellosis can be nonspecific, making the diagnosis challenging. Osteoarticular involvement is the most common complication of brucellosis. Mortality from brucellosis is low except for endocarditis and involvement of the central nervous system. The diagnosis is based on laboratory tests and clinical manifestations. Serological tests are preferred, as culture methods can be unreliable. A 59-year-old woman presented with gastrointestinal bleeding, fever, anorexia and malaise. She had a history of aortic valve replacement with a mechanical prosthesis for severe bicuspid aortic stenosis. Investigations revealed a multiloculated aortic root abscess encircling the prosthetic valve. She was diagnosed with brucella endocarditis, treated with antibiotics and underwent cardiac surgery. Her symptoms improved following the surgery. Brucellosis prosthetic valve endocarditis is a rare presentation of this disease.
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Affiliation(s)
- Abdullah K Alassiri
- Correspondence address. College of Medicine, King Abdul Aziz University (KAU), Jeddah, Saudi Arabia. Tel: +966-2-6401000 ext 20094-20096; Fax: ext 20127; E-mail: ,
| | - Fahad M Alshair
- Cardiac Surgery Unit, Department of Surgery, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Mazin A Fatani
- Cardiac Surgery Unit, Department of Surgery, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Abdullah H Baghaffar
- Cardiac Surgery Unit, Department of Surgery, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
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5
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Boukobza M, Raffoul R, Duval X, Laissy JP. [Not Available]. Ann Cardiol Angeiol (Paris) 2022; 71:240-242. [PMID: 35940971 DOI: 10.1016/j.ancard.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/27/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Prevotella species (i. e. P. intermedia, P. nigrescens, P. pallens, P. oris) are usually responsible for abscesses of head and neck spaces after dental procedures. P. intermedia - related infective endocarditis has never been reported. CASE REPORT A 22-year-old man, with a history of aortic valve replacement 6 years ago, presented with fever and persistent retrosternal chest pain. An empirical antibiotic therapy was started on (cefotaxime, 2gx3 - gentamicin, 5mg/kilo). Five blood cultures were positive at Prevotella Intermedia. Metronidazole was introduced (500mg X 3 by day).The oro-pharyngeal spaces were normal. The evolution was marked by a hypotension, a third degree atrio-ventricular block, and a rapidly growing aortic root abscess complicated this case of Prevotella Intermedia infective endocarditis (IE). Aortic valve redux surgery was performed at day 5 of admission. Post-operative course was unremarkable. CONCLUSION This first reported case of Prevotella Intermedia IE presented suggestive features of anaerobic IE as the patient developed both aortic-ring abscess, third degree atrio-ventricular block and hypotension.
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Affiliation(s)
- Monique Boukobza
- Department of Radiology, Bichat-Claude-Bernard Hospital, Assistance Publique-Hôpitaux de Paris, 46 rue Henri Huchard, 75018, Paris, FRANCE.
| | - Richard Raffoul
- Department of Cardiac Surgery, Bichat-Claude-Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Xavier Duval
- Department of Infectious Diseases, Bichat-Claude-Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France ; INSERM Clinical Investigation Center 007, Paris, France ; INSERM U738, Paris, France ; Paris University, France
| | - Jean-Pierre Laissy
- Department of Radiology, Bichat-Claude-Bernard Hospital, Assistance Publique-Hôpitaux de Paris , Paris, France ; INSERM U1148, Paris, France ; Paris University, Paris, France
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Kandachar PS, Balushi AA, Al Aamri I, Al-Khouri MAJA, Menon RG, Zacharias S. Aortic root abscess and anomalous aortic origin of right coronary artery in a 5-year-old child. J Card Surg 2022; 37:3872-3875. [PMID: 36054378 DOI: 10.1111/jocs.16877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 07/27/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Aortic root abscess is a rare complication of infective endocarditis in children. CASE REPORT A 5-year-old boy with infective endocarditis of aortic valve and an anterior aortic root abscess was found to have anomalous aortic origin of right coronary artery from the left coronary sinus on computed tomography scan with contrast. RESULT He was managed surgically by "patch and prosthesis" approach and required aortic root enlargement. Since anomalous aortic origin of right coronary artery is a relative contraindication for a Konno-Rastan aortic root enlargement, a Manouguian procedure was performed. CONCLUSION Anterior aortic root abscesses are rare, the co-existence of anomalous aortic origin of right coronary artery is rarer still and such cases requiring aortic root enlargement are possibly best served by a Manouguian procedure.
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Affiliation(s)
| | | | - Is'haq Al Aamri
- Department of Cardiac Anesthesia, Royal Hospital, Muscat, Oman
| | | | - Raj Gopal Menon
- Department of Cardiothoracic Surgery, Royal Hospital, Muscat, Oman
| | - Sunny Zacharias
- Department of Cardiothoracic Surgery, Royal Hospital, Muscat, Oman
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Yajima S, Sakashita Y, Sekiya N, Sakaguchi T. A novel patch-sparing technique for reconstruction of the aorto-mitral curtain. Eur J Cardiothorac Surg 2022; 62:6651840. [PMID: 35904768 DOI: 10.1093/ejcts/ezac405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/23/2022] [Accepted: 07/27/2022] [Indexed: 11/12/2022] Open
Abstract
We described a novel technique for reconstructing the aorto-mitral curtain using autologous tissue. This technique was performed on a patient requiring replacement of both aortic and mitral valves and aortic root due to recurrent prosthetic valve infection and aortic root abscess. The aorto-mitral curtain was reconstructed without using any artificial patches. Instead, surrounding autologous tissues were used, including the residual healthy left atrial and aortic basal tissues. This patch-sparing technique may be occasionally feasible to perform and may serve as a secure anchor for subsequent aortic root replacement.
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Affiliation(s)
- Shin Yajima
- Department of Cardiovascular Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya City, Hyogo, Japan
| | - Yuji Sakashita
- Department of Cardiovascular Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya City, Hyogo, Japan
| | - Naosumi Sekiya
- Department of Cardiovascular Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya City, Hyogo, Japan
| | - Taichi Sakaguchi
- Department of Cardiovascular Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya City, Hyogo, Japan
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8
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Harris WM, Sinha S, Caputo M, Angelini GD, Ahmed EM, Rajakaruna C, Benedetto U, Vohra HA. Surgical outcomes and optimal approach to treatment of aortic valve endocarditis with aortic root abscess. J Card Surg 2022; 37:1917-1925. [PMID: 35384049 PMCID: PMC9321057 DOI: 10.1111/jocs.16464] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/13/2022] [Accepted: 02/19/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To evaluate the impact of aortic root abscess (ARA) on the postoperative outcomes of surgically managed infective endocarditis (IE) and to inform optimal surgical approach. METHODS Between 2009 and 2020, 143 consecutive patients who underwent surgical management for aortic-valve IE were included in a retrospective cohort study. Multivariable and propensity-weighted analyses were used to adjust for demographic imbalances between those without (n = 93; NARA) and with an ARA (n = 50). Additionally, empirical subgroup analysis appraised the two most used surgical techniques; patch reconstruction (PR) and aortic root replacement (ARR). RESULTS Demographic characteristics were similar between ARA and NARA except for logistic EuroSCORE, previous valve surgery, and multivalvular infection. In-hospital mortality was 8% and 12% in NARA and ARA, respectively (p = .38), with mortality rates consistently nonsignificantly higher in ARA across all time periods. The overall reoperation rate was also higher in ARA (27% vs. 14%; p = .09) and ARA was shown to be associated with late reoperation (odds ratio [OR] = 2.74; 95% confidence interval [CI] = 1.18-6.36). Patients treated with an ARR showed a 16% increase in late mortality when compared with PR (40% vs. 24%; p = .27) and a 17% lower reoperation rate (14% vs. 31%; p = .24). Propensity-weighted analysis identified ARR as a significant protective factor for reoperation (hazard ratio = 0.05; 95% CI = 0.01-0.34). CONCLUSIONS The presence of an ARA in aortic valve endocarditis was not associated with significantly higher early and late mortality but is linked with a higher reoperation rate at our institution. ARR in ARA is protective from reoperation so should be considered best practice in this setting.
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Affiliation(s)
- William M. Harris
- Bristol Heart InstituteUniversity Hospitals Bristol NHS Foundation TrustBristolUK
| | - Shubhra Sinha
- Bristol Heart InstituteUniversity Hospitals Bristol NHS Foundation TrustBristolUK
| | - Massimo Caputo
- Bristol Heart InstituteUniversity Hospitals Bristol NHS Foundation TrustBristolUK
| | - Gianni D. Angelini
- Bristol Heart InstituteUniversity Hospitals Bristol NHS Foundation TrustBristolUK
| | - Eltayeb M. Ahmed
- Bristol Heart InstituteUniversity Hospitals Bristol NHS Foundation TrustBristolUK
| | - Cha Rajakaruna
- Bristol Heart InstituteUniversity Hospitals Bristol NHS Foundation TrustBristolUK
| | - Umberto Benedetto
- Bristol Heart InstituteUniversity Hospitals Bristol NHS Foundation TrustBristolUK
| | - Hunaid A. Vohra
- Bristol Heart InstituteUniversity Hospitals Bristol NHS Foundation TrustBristolUK
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9
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Straw S, Baig MW, Mishra V, Gillott R, Witte KK, Van Doorn C, Ferrara A, Javangula K, Sandoe JAT. Surgical Techniques and Outcomes in Patients With Intra-Cardiac Abscesses Complicating Infective Endocarditis. Front Cardiovasc Med 2022; 9:875870. [PMID: 35711342 PMCID: PMC9194824 DOI: 10.3389/fcvm.2022.875870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/13/2022] [Indexed: 11/13/2022] Open
Abstract
Background An intra-cardiac abscess is a serious complication of both native (NV-IE) and prosthetic valve infective endocarditis (PV-IE). Despite being an accepted indication for surgery, controversies remain regarding the optimal timing and type of operation. We aimed to report the outcomes of patients managed for intra-cardiac abscesses over more than a decade. Methods Patients aged ≥18 years managed for intra-cardiac abscess between 1 January 2005 and 31 December 2017 were identified from a prospectively collected IE database. The primary outcome was 30-day mortality in operated patients and secondary outcomes were freedom from re-infection, re-operation and long-term mortality comparing those patients with aortic root abscess who underwent aortic valve replacement (AVR) and those who received aortic root replacement (ARR). Results Fifty-nine patients developed an intra-cardiac abscess, and their median age was 55 (43-71) years; among them, 44 (75%) were men, and 10 (17%) were persons who injected drugs. Infection with beta-haemolytic streptococci was associated with NV-IE (p = 0.009) and coagulase-negative staphylococci with PV-IE (p = 0.005). Forty-four (75%) underwent an operation, and among those with aortic root abscess, 27 underwent AVR and 12 ARR. Thirty-day mortality was associated with infection with S. aureus (p = 0.006) but not the type or timing of the operation. Survival in operated patients was 66% at 1 year and 59% at 5 years. In operated patients, none had a relapse, although six developed late recurrence. Freedom from infection, re-operation and long-term mortality were similar in patients undergoing AVR compared to ARR. Conclusion Patients diagnosed with intra-cardiac abscess who were not operated on had very poor survival. In those who underwent an operation, either by AVR or ARR based upon patient factors, imaging and intra-operative findings outcomes were similar.
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Affiliation(s)
- Sam Straw
- Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - M. Wazir Baig
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Vishal Mishra
- Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Richard Gillott
- Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Klaus K. Witte
- Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Carin Van Doorn
- Department of Cardiothoracic Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Antonella Ferrara
- Department of Cardiothoracic Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Kalyana Javangula
- Department of Cardiothoracic Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Jonathan A. T. Sandoe
- Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
- Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
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10
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Petrov A, Diab AH, Taghizadeh-Waghefi A, Wilbring M, Alexiou K, Matschke KE, Tugtekin SM, Kappert U. Aortic root reinforcement in aortic valve endocarditis with annular abscess: The Calamari procedure. J Card Surg 2022; 37:2202-2204. [PMID: 35451081 DOI: 10.1111/jocs.16517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/08/2022] [Accepted: 03/12/2022] [Indexed: 11/29/2022]
Abstract
Treatment of infective endocarditis can often prove challenging due to its wide range of anatomical presentations. When complicated by an aortic root abscess, patients may require extensive root surgery, which on its own leads to a worse outcome. We present our experience with a surgical technique for reinforcing the aortic annulus with a ring from a Dacron aortic prosthesis placed in the left ventricular outflow tract to avoid the need for root replacement procedures or patch closures of the defect. The technique described in this paper provides a viable alternative to the standard techniques used for the treatment of annular abscesses in aortic valve endocarditis. Due to the relative simplicity and ease of use, this approach may present a means of reducing operation time and possibly postoperative complications of this severe condition.
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Affiliation(s)
- Asen Petrov
- Department of Cardiac Surgery, University Heart Center Dresden, Medical Faculty of the Technical University of Dresden, Dresden, Germany
| | - Abdel-Hannan Diab
- Department of Cardiac Surgery, University Heart Center Dresden, Medical Faculty of the Technical University of Dresden, Dresden, Germany
| | - Ali Taghizadeh-Waghefi
- Department of Cardiac Surgery, University Heart Center Dresden, Medical Faculty of the Technical University of Dresden, Dresden, Germany
| | - Manuel Wilbring
- Department of Cardiac Surgery, University Heart Center Dresden, Medical Faculty of the Technical University of Dresden, Dresden, Germany
| | - Konstantin Alexiou
- Department of Cardiac Surgery, University Heart Center Dresden, Medical Faculty of the Technical University of Dresden, Dresden, Germany
| | - Klaus Erhard Matschke
- Department of Cardiac Surgery, University Heart Center Dresden, Medical Faculty of the Technical University of Dresden, Dresden, Germany
| | - Sems-Malte Tugtekin
- Department of Cardiac Surgery, University Heart Center Dresden, Medical Faculty of the Technical University of Dresden, Dresden, Germany
| | - Utz Kappert
- Department of Cardiac Surgery, University Heart Center Dresden, Medical Faculty of the Technical University of Dresden, Dresden, Germany
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11
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Ojha U, Ayathamattam J, Ahmad S. Catastrophic case of suppurative, embolic and fistulating infective endocarditis causing complete heart block. Future Cardiol 2022; 18:385-391. [PMID: 35403433 DOI: 10.2217/fca-2021-0124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Complete heart block, aortic root abscess and aortic valve regurgitation are well-recognized complications of infective endocarditis of the aortic valve. Splenic abscess and aorto-cavitary fistula are rarer phenomena and are indicative of calamitous infection. The authors present the case of an otherwise healthy 61-year-old man presenting with a 2-month history of non-specific symptoms, who developed suppurative endocarditis with a fistulating aortic root abscess, combined with severe sepsis, splenic embolization and complete heart block. Staphylococcus lugdunensis was the causative bacterium identified. The combination of these sequelae in the same patient is sparsely reported, is exceedingly rare and carries a significant risk of mortality.
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Affiliation(s)
- Utkarsh Ojha
- Royal Brompton & Harefield Hospitals, Hill End Road, Harefield, Uxbridge, UB9 6JH, UK
| | | | - Saad Ahmad
- Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK
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12
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Chandrasekhar S, Lee DH, Patel N, Bassily E, Chen A. A Case of Rapid Development of Methicillin‑Resistant Staphylococcus aureus Mechanical Aortic Root Abscess Despite Appropriate Antibiotic Use. Cureus 2021; 13:e17494. [PMID: 34603875 PMCID: PMC8476190 DOI: 10.7759/cureus.17494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 08/27/2021] [Indexed: 11/20/2022] Open
Abstract
A 74-year-old male with a past medical history of mechanical aortic valve replacement presented with abdominal pain and fever. Blood cultures revealed methicillin-resistant Staphylococcus aureus (MRSA) and the patient was started on target antibiotics. Initial transthoracic echocardiogram and transesophageal echocardiogram (TEE) did not show any vegetations or significant valvular regurgitation. No other sources of infection were identified. Five days after the initial TEE, a repeat TEE revealed new areas of thickening and echolucency seen anterior to the mechanical aortic valve, suggestive of aortic root abscess (AoRA). It also extended down the mitral-aortic intervalvular fibrosa and was associated with mitral valvular vegetation. Due to worsening clinical status and persistent bacteremia on appropriate antibiotics, a high index of suspicion for infective endocarditis (IE) remained after the initial TEE. As such, the repeat TEE was obtained only five days after and demonstrated clear evidence of rapidly growing endocarditis and abscess formation. This case uniquely demonstrates how rapid MRSA endocarditis may progress and emphasizes its high mortality. This case highlights the importance of a low threshold for repeat imaging when the index of suspicion for endocarditis remains high despite negative imaging.
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Affiliation(s)
| | - Dae Hyun Lee
- Cardiology, University of South Florida, Tampa, USA
| | - Nidhi Patel
- Cardiology, University of South Florida, Tampa, USA
| | | | - Allan Chen
- Cardiology, Orlando Health Heart Institute, Orlando, USA
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13
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Kinthala S, Yarramneni A, Huang J, Yepuri N, Saththasivam P, Sattur S. Perioperative Evaluation of Infective Endocarditis Via Multimodality Imaging for the Surgical Management of Aortic Root Abscess. Cureus 2021; 13:e17817. [PMID: 34660027 PMCID: PMC8500339 DOI: 10.7759/cureus.17817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2021] [Indexed: 11/06/2022] Open
Abstract
Infective endocarditis (IE) is an infection of the endothelium of the heart, that typically affects heart valves. While echocardiography remains crucial in the diagnosis and management of IE, multimodality cardiac imaging helps obtain additional information for the management of complex cases. Alternative imaging modalities such as computed tomography (CT), computed tomography angiography (CTA), and magnetic resonance imaging (MRI) are playing an increasing role in the diagnosis and management of IE, especially for patients with prosthetic valve endocarditis (PVE). Here we present a case of a 60-year-old Caucasian male who was diagnosed with IE, complicated by aortic root abscess, and multiorgan failure. In this challenging case, multimodality cardiac imaging helped in the precise understanding of the extent of endocarditis, cannulation strategy, and direct the course of the surgical procedure that resulted in successful patient management.
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Affiliation(s)
| | - Akhila Yarramneni
- Department of Surgery, Division of Cardiac Surgery, Guthrie Robert Packer Hospital, Sayre, USA
| | - Jordan Huang
- Anesthesiology, Guthrie Robert Packer Hospital, Sayre, USA
| | - Natesh Yepuri
- Anesthesiology, Guthrie Robert Packer Hospital, Sayre, USA
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14
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Khan MZ, Franklin S, Zahid S, Kutalek S, Kilcoyne J. Shock Secondary to Aortic Root Abscess With Sterile Blood Culture. Cureus 2021; 13:e15262. [PMID: 34189000 PMCID: PMC8232978 DOI: 10.7759/cureus.15262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Shock caused by an aortic root abscess is a rare phenomenon. Due to its rarity, it is commonly not diagnosed on time to have a favorable prognosis for the patient. Our case involves an 80-year-old male presenting with leukocytosis, lactic acidosis, and hypoglycemia. Initial studies were not fruitful in determining the cause of septic shock. However, an echocardiogram conducted to clarify the finding of a non-ST segment myocardial infraction led to the incidental finding of an aortic root abscess with retrograde flow, suggesting a perforated abscess without endocarditis. Though the patient expired on day seven, our case demonstrates the importance of echocardiography in diagnosing an aortic root abscess in cases with a sterile blood culture and uneventful initial lab investigations.
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Affiliation(s)
| | - Sona Franklin
- Internal Medicine, St. Mary Medical Center, Langhorne, USA
| | - Shaheer Zahid
- Medicine, Saint James School of Medicine, Park Ridge, USA
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15
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Kohli U, Obuobi S, Addetia K, Ota T, Nayak HM. PR interval prolongation is significantly associated with aortic root abscess: An age- and gender-matched study. Ann Noninvasive Electrocardiol 2021; 26:e12849. [PMID: 33939235 PMCID: PMC8293599 DOI: 10.1111/anec.12849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/04/2021] [Accepted: 03/16/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Electrocardiographic abnormalities, such as PR interval prolongation, have been anecdotally reported in patients with aortic root abscess (ARA). An electrocardiographic marker may be useful in identifying those patients with aortic valve endocarditis who may progress to ARA. The objective of this study is to evaluate the change in the PR interval in patients with surgically confirmed ARA and compare it to age- and gender-matched controls with echocardiographically or surgically confirmed aortic valve endocarditis but without aortic root abscess and those hospitalized with diagnoses other than endocarditis. METHODS Patients were eligible for enrollment if they were 18 years or older and were hospitalized for either ARA, aortic valve endocarditis, or for unrelated reasons and had at least one 12-lead electrocardiogram (ECG) prior to or on the day of hospitalization and at least one ECG after hospitalization but prior to any cardiac surgical procedure. Delta PR interval, defined as the difference between the pre- and post-admission PR interval, was the primary outcome of interest. The patients in the ARA group were age- and gender-matched to patients with aortic valve endocarditis and to those without endocarditis. Comparisons of demographic variables and study outcomes were performed. RESULTS Eighteen patients with surgically confirmed ARA were enrolled. These patients were age- and gender-matched to 19 patients with aortic valve endocarditis and 18 patients with no past history or evidence of endocarditis during hospitalization. No difference was noted in the baseline PR interval between the groups. However, the PR interval following admission in the aortic root abscess group (201 ± 66 ms) was significantly longer than the PR interval in both the aortic valve endocarditis (162 ± 27 ms) (24%, p = .009) and no endocarditis (143 ± 24 ms) (40%, p < .001) groups. The primary outcome measure, delta PR interval, was significantly longer in the ARA group (35 ± 51 ms) than no endocarditis (-5 ± 17 ms) (p = .001) and aortic valve endocarditis groups (0.2 ± 18) (p = .003). CONCLUSIONS The findings of our study support the notion that the PR interval is more likely to be prolonged in patients with ARA. Since ARA is associated with a high morbidity and mortality, PR interval prolongation in a patient with aortic valve endocarditis should prompt a thorough evaluation for aortic root involvement.
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Affiliation(s)
- Utkarsh Kohli
- Department of Pediatrics, Comer Children's Hospital and Pritzker School of Medicine of the University of Chicago, Chicago, IL, USA
| | - Shirlene Obuobi
- Heart & Vascular Center, Pritzker School of Medicine of the University of Chicago, Chicago, IL, USA
| | - Karima Addetia
- Heart & Vascular Center, Pritzker School of Medicine of the University of Chicago, Chicago, IL, USA
| | - Takeyoshi Ota
- Heart & Vascular Center, Pritzker School of Medicine of the University of Chicago, Chicago, IL, USA
| | - Hemal M Nayak
- Heart & Vascular Center, Pritzker School of Medicine of the University of Chicago, Chicago, IL, USA
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16
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Chitkara A, Anamika, Sharma VK, Puri P, Pusapati S. Aortic Root Dilatation With Healed Aortic Root Abscess, Asymptomatic for 41 Years. Cureus 2020; 12:e10113. [PMID: 33016960 PMCID: PMC7526066 DOI: 10.7759/cureus.10113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A 61-year-old patient presented to us with complaints of mild fever, rhinorrhea, sneezing, and dry cough. On auscultation, there was harsh vesicular breath sound with bilateral audible wheezing but no crackles. Also, a soft high-pitched early diastolic decrescendo murmur in third intercostal space on the left side, typical of aortic regurgitation (AR) was heard. History revealed that in 1976 he was diagnosed with AR and later in 1990 he was diagnosed with aortic root dilatation (AoD) with healed aortic root abscess (ARA). He had no history of infective endocarditis and has remained asymptomatic. The latest echocardiography revealed mild left ventricular hypertrophy (LVH) with Grade 1 LV diastolic dysfunction but no left ventricular (LV) wall motion abnormality. The patient was advised to take tablet losartan 20 mg OD to arrest the progression of his mild LVH and its related complications and continue with his lifestyle management and routine echocardiography. In some rare cases, AoD with healed ARA can remain asymptomatic over the course of decades. Regular follow up exams (every one to two years), with proper management, is the mainstay of management, along with the treatment of comorbid conditions.
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Affiliation(s)
- Akshit Chitkara
- Internal Medicine, Sh. Moolchand Super Speciality Hospital, Karnal, IND
| | - Anamika
- Internal Medicine, Mahatama Gandhi Institute of Medical Sciences, Hisar, IND
| | | | - Piyush Puri
- Internal Medicine, Al Flah School of Medical Sciences and Research Center, Faridabad, IND
| | - Sneha Pusapati
- Internal Medicine, State University of New York (SUNY) Downstate, New York, USA
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17
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Choudhury I, Han H, Manthani K, Gandhi S, Dabhi R. COVID-19 as a Possible Cause of Functional Exhaustion of CD4 and CD8 T-cells and Persistent Cause of Methicillin-Sensitive Staphylococcus aureus Bacteremia. Cureus 2020; 12:e9000. [PMID: 32775080 PMCID: PMC7402531 DOI: 10.7759/cureus.9000] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
We report a case of a 73-year-old male with a history of diabetes mellitus, osteomyelitis, methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia who recently completed an extended intravenous course of cefazolin eight days back, and presented with MSSA bacteremia complicated by epidural abscess, endocarditis, and aortic root abscess. Meanwhile, the patient was tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse transcription-polymerase chain reaction (RT-PCR). Even with aggressive antibiotic treatment, the patient remained bacteremic and developed endocarditis with a worsening aortic root abscess. We suspect coronavirus disease 2019 (COVID-19) as a cause for the infectious paradox and will discuss the possible mechanisms in this case report.
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Affiliation(s)
- Ivana Choudhury
- Family Medicine, Kaweah Delta Health Care District, Visalia, USA.,Family Medicine, Peconic Bay Medical Center-Northwell Health, Riverhead, USA
| | - Haowei Han
- Family Medicine, Peconic Bay Medical Center-Northwell Health, Riverhead, USA
| | - Kaushik Manthani
- Family Medicine, Peconic Bay Medical Center-Northwell Health, Riverhead, USA
| | - Sandeep Gandhi
- Medicine, Peconic Bay Medical Center-Northwell Health, Riverhead, USA
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18
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Abstract
Cutibacterium acnes is a skin commensal which is most often regarded as a contaminant when detected on blood cultures. In rare instances, it may be the causative pathogen in severe systemic illnesses. Subacute endocarditis, especially of prosthetic valves and devices, is an important grave pathology caused by Cutibacterium acnes. Herein we report two cases of prosthetic valve endocarditis with varied presentations as valve dehiscence with a "rocking" prosthetic valve apparatus in one encounter and as a septic embolic stroke in the second encounter. Although a rare cause of endocarditis, it becomes an especially important entity in patients with prosthetic devices and should be high in the list of differentials.
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Affiliation(s)
- Samra Haroon Lodhi
- Internal Medicine, King Edward Medical University, Lahore, PAK.,Internal Medicine, Mayo Hospital, Lahore, PAK
| | - Ayesha Abbasi
- Internal Medicine, King Edward Medical University, Lahore, PAK.,Internal Medicine, Mayo Hospital, Lahore, PAK
| | - Taha Ahmed
- Internal Medicine, Cleveland Clinic Foundation, Cleveland, USA
| | - Albert Chan
- Cardiovascular Medicine, Cleveland Clinic Fairview Hospital, Cleveland, USA
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19
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Yang B, Caceres J, Farhat L, Le T, Brown B, St Pierre E, Wu X, Kim KM, Patel HJ, Deeb GM. Root abscess in the setting of infectious endocarditis: Short- and long-term outcomes. J Thorac Cardiovasc Surg 2020; 162:1049-1059.e1. [PMID: 32418636 DOI: 10.1016/j.jtcvs.2019.12.140] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 12/09/2019] [Accepted: 12/12/2019] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To evaluate the influence of an aortic root abscess on perioperative outcomes and long-term survival in patients with active infectious endocarditis that was treated surgically. METHODS From 1996 to 2017, 336 consecutive patients were treated with aortic valve or root replacement for infective endocarditis, including patients with (n = 179) or without (n = 157) a root abscess. Data were obtained from the Society of Thoracic Surgeons data warehouse, through chart review, patient surveys, and National Death Index data. RESULTS Demographic characteristics were similar between groups except the root abscess group had a significantly lower prevalence of congestive heart failure and higher rates of prosthetic valve endocarditis. The abscess group had significantly more aortic root replacements as well as longer cardiopulmonary bypass and crossclamp times. Operative mortality was 8.4% and 3.8% (P = .11) for the abscess and no abscess groups, respectively. Nevertheless, the root-abscess group had prolonged ventilation and longer intensive care unit stays. Kaplan-Meier survival was similar between root abscess and no abscess groups (10-year survival 41% vs 43%; P = .35). Significant risk factors for all-time mortality included age greater than 70 (hazard ratio [HR], 2.85; 95% confidence interval [CI], 1.55, 5.24), the presence of a root abscess (HR, 1.42; 95% CI, 1.02, 1.96), intravenous drug use (HR, 1.81; 95% CI, 1.13, 2.89), congestive heart failure (HR, 1.72; 95% CI, 1.22, 2.42), renal failure requiring dialysis (HR, 3.26; 95% CI, 2.30, 4.64), liver disease (HR, 3.04; 95% CI, 1.65, 5.60), and postoperative sepsis (HR, 3.00; 95% CI, 1.30, 6.93). The 10-year rate of reoperation was also similar between groups (5.9% vs 7.9%). CONCLUSIONS Thorough and extensive debridement is critical for successful treatment of active endocarditis with root abscess. Bioprosthetic stented and stentless valves are valid conduits to treat endocarditis with root abscess.
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Affiliation(s)
- Bo Yang
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich.
| | - Juan Caceres
- University of Michigan Medical School, Ann Arbor, Mich
| | - Linda Farhat
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Tan Le
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Bailey Brown
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Emma St Pierre
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Xiaoting Wu
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Karen M Kim
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Himanshu J Patel
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - G Michael Deeb
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
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20
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Kariyanna PT, Tadayoni A, Jayarangaiah A, Yadav V, Vulkanov V, Budzikowski A, Salifu MO, McFarlane SI. Significant PR Prolongation and New Onset Left Bundle Branch Block in Aortic Root Abscess: A Marker of Disease Progression and Poor Prognosis. Am J Med Case Rep 2020; 8:315-20. [PMID: 32671194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Infective endocarditis (IE) is a serious medical condition with a high morbidity and mortality rate. Staphylococcus aureus is the most common etiologic organism in IE. While echocardiography plays an important role in diagnosis and management of IE, the electrocardiogram (ECG) is helpful in determination of disease progression as well as in prognostication. We present a case of a 72-year-old man who was diagnosed with IE following methicillin resistant Staphylococcus aureus (MRSA) bacteremia. The course of hospitalization was complicated with multiple septic-embolic strokes and aortic root abscess. Serial ECG revealed PR prolongation and new onset left bundle branch block (LBBB) before the patient became terminal. Our case highlights the utility of serial ECGs monitoring in the patients with IE that may reveal subtle ECG findings, such as PR prolongation and LBBB. These findings which might serve as a clue of the presence of peri-annular extension of IE, help in prognostication and aid in the therapeutic decision-making such as early surgical intervention in these high-risk patients with poor prognosis. In this report, we also present the pathophysiologic mechanisms underlining the ECG changes in patients with aortic valve endocarditis.
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21
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Ahluwalia V, Osman F, Parmar J, Khan JN. 3D echocardiography allows rapid and accurate surgical planning in complex aortic root abscess cases. Echo Res Pract 2019; 6:ERP-19-0043.R1. [PMID: 31730045 PMCID: PMC6893311 DOI: 10.1530/erp-19-0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 10/23/2019] [Indexed: 11/18/2022] Open
Abstract
Despite 3D echocardiography (3DE) acquiring significantly greater data than standard 2D echocardiography (2DE), it is underutilized in assessing cardiac anatomy and physiology. A key advantage is the ability of a single 3DE acquisition to be post-processed to generate volume rendered 3D models and an unlimited number of multiplanar reconstruction (MPR) images. We describe the case of a highly anxious patient with life-threatening complex aortic valve endocarditis and aortic root abscess, refusing transesophageal echocardiography (TOE) under general anaesthesia with tachycardia, breathlessness and acute kidney injury precluding accurate or safe gated (computed tomography) CT, who was comprehensively assessed with a rapid 3DE-TOE under sedation. This led to timely surgery and an excellent outcome for the patient.
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Affiliation(s)
- Viren Ahluwalia
- Department of Cardiology, University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Faizel Osman
- Department of Cardiology, University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
- Warwick Medical School, Warwick University, Coventry, UK
| | - Jitendra Parmar
- Department of Cardiology, University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Jamal Nasir Khan
- Department of Cardiology, University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
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22
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Bindroo S, Akhter S, Thakur K, Geller C. Austrian Triad Complicated by Septic Arthritis and Aortic Root Abscess. Cureus 2018; 10:e3018. [PMID: 30254807 PMCID: PMC6150766 DOI: 10.7759/cureus.3018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 07/20/2018] [Indexed: 11/05/2022] Open
Abstract
Austrian syndrome is a very rare manifestation of invasive Streptococcus pneumoniae infection comprising a triad of pneumonia, meningitis, and endocarditis, also known as Osler's triad. We herein report a rare case of Austrian syndrome further complicated by septic arthritis.
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Affiliation(s)
- Sandiya Bindroo
- Internal Medicine, Crozer Chester Medical Center, Upland, USA
| | - Shafinaz Akhter
- Infectious Disease, Penn Medicine Chester County Hospital, Mount Laurel, USA
| | - Kshitij Thakur
- Internal Medicine, University of Kentucky College of Medicine, Kentucky, USA
| | - Charles Geller
- Cardiothoracic Surgery, Crozer Chester Medical Center, Upland, USA
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23
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Al Emam AR, Moulton M, Hyden M, Chatzizisis Y. A Giant Aortic Root Abscess. Methodist Debakey Cardiovasc J 2018; 14:150. [PMID: 29977473 DOI: 10.14797/mdcj-14-2-150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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24
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Sultan I, Bianco V, Kilic A, Chu D, Navid F, Gleason TG. Aortic root replacement with cryopreserved homograft for infective endocarditis in the modern North American opioid epidemic. J Thorac Cardiovasc Surg 2018; 157:45-50. [PMID: 30285921 DOI: 10.1016/j.jtcvs.2018.05.050] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 05/08/2018] [Accepted: 05/14/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To study mid-term survival in patients with infective endocarditis as a result of IV drug use undergoing aortic root replacement with cryopreserved aortic homograft. METHODS Patients undergoing aortic root homograft replacement from 2011-2017 were studied retrospectively. Aortic root replacement was performed using a modified Bentall technique. Primary outcomes included both short-term and mid-term survival. Secondary outcomes included immediate postoperative complications. RESULTS A total of 138 patients underwent cryopreserved homograft replacement of the aortic root for aortic root abscesses. Eighty-five patients (61.6%) underwent reoperative sternotomy, and 12 patients (8.7%) underwent second or third reoperative sternotomy. Sixty-seven (48.5%) patients had severe aortic insufficiency preoperatively. Operative mortality was 12.3% (17 patients). Five patients (3.6%) sustained a permanent stroke. Twenty-one patients (15.2%) required dialysis for renal failure, and 21 patients (15.2%) had complete heart block necessitating a permanent pacemaker. Estimated 5-year mortality for the cohort was 43%. CONCLUSIONS Cryopreserved homograft replacement is a safe and desirable option for high-risk patients with infective endocarditis and aortic root abscess. Homograft accommodation for a widely debrided aortic annular bed provides a reasonable surgical strategy for patients needing aortic root replacement with annular abscess.
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Affiliation(s)
- Ibrahim Sultan
- Division of Cardiac Surgery, University of Pittsburgh and Heart and Vascular Institute, Univeristy of Pittsburgh Medical Center, Pittsburgh, Pa.
| | - Valentino Bianco
- Division of Cardiac Surgery, University of Pittsburgh and Heart and Vascular Institute, Univeristy of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Arman Kilic
- Division of Cardiac Surgery, University of Pittsburgh and Heart and Vascular Institute, Univeristy of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Danny Chu
- Division of Cardiac Surgery, University of Pittsburgh and Heart and Vascular Institute, Univeristy of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Forozan Navid
- Division of Cardiac Surgery, University of Pittsburgh and Heart and Vascular Institute, Univeristy of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Thomas G Gleason
- Division of Cardiac Surgery, University of Pittsburgh and Heart and Vascular Institute, Univeristy of Pittsburgh Medical Center, Pittsburgh, Pa
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25
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Sekar B, Wheeler R, Masani N, Gallagher S. Myocardial ischaemia as a result of external coronary compression from infective aortic root aneurysm: atypical presentation of prosthetic valve endocarditis. Echo Res Pract 2018; 5:K35-K40. [PMID: 29643124 PMCID: PMC5948197 DOI: 10.1530/erp-18-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 04/11/2018] [Indexed: 12/02/2022] Open
Abstract
This case describes an unusual presentation of prosthetic valve endocarditis (PVE): an acute coronary syndrome. A 67-year-old male presented with cardiac sounding chest pain on a background of a short history of night sweats, weight loss and general malaise. Four months previously, he had undergone bio-prosthetic aortic valve replacement for severe aortic stenosis and single vessel bypass grafting of the obtuse marginal. Whilst having chest pain, his ECG showed infero-lateral ST depression. Early coronary angiography revealed a new right coronary artery (RCA) lesion that was not present prior to his cardiac surgery. Using multi-modality cardiac imaging, the diagnosis of PVE was made. An aortic root abscess was demonstrated that was causing external compression of the RCA.
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Affiliation(s)
- Baskar Sekar
- Cardiology Department, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, UK
| | - Richard Wheeler
- Cardiology Department, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, UK
| | - Navroz Masani
- Cardiology Department, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, UK
| | - Sean Gallagher
- Cardiology Department, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, UK
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26
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Fernando RJ, Johnson SD, Augoustides JG, Patel PA, Gutsche JT, Dashiell JM, Feinman JW, Zhou E, Weiss SJ, Goldhammer JE, Panikkath PV, Gerstein NS. Simultaneous Right-Sided and Left-Sided Infective Endocarditis: Management Challenges in a Multidisciplinary Setting. J Cardiothorac Vasc Anesth 2017; 32:1041-1049. [PMID: 29249580 DOI: 10.1053/j.jvca.2017.07.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Indexed: 02/08/2023]
Affiliation(s)
- Rohesh J Fernando
- Cardiothoracic Section, Department of Anesthesiology, Wake Forest University School of Medicine, Winston Salem, NC
| | - Sean D Johnson
- Cardiothoracic Section, Department of Anesthesiology, Wake Forest University School of Medicine, Winston Salem, NC
| | - John G Augoustides
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Prakash A Patel
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jacob T Gutsche
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jillian M Dashiell
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jared W Feinman
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Elizabeth Zhou
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Stuart J Weiss
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jordan E Goldhammer
- Adult Cardiothoracic Anesthesiology, Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Pramod V Panikkath
- Division of Cardiac Anesthesia, Department of Anesthesiology, University of New Mexico, Albuquerque, NM
| | - Neal S Gerstein
- Division of Cardiac Anesthesia, Department of Anesthesiology, University of New Mexico, Albuquerque, NM
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27
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Raju IT, Solanki R, Patnaik AN, Barik RC, Kumari NR, Gulati AS. Brucella endocarditis - a series of five case reports. Indian Heart J 2013; 65:72-7. [PMID: 23438616 PMCID: PMC3860836 DOI: 10.1016/j.ihj.2012.12.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Revised: 08/24/2012] [Accepted: 12/19/2012] [Indexed: 11/24/2022] Open
Abstract
Endocarditis due to brucellosis is considered a rare occurrence involving native, congenital and prosthetic valves. The diagnosis needs high degree of suspicion in culture negative endocarditis especially in those with history of exposure to farm animals. A positive culture in a susceptible patient confirms the diagnosis with 91% sensitivity. An early diagnosis and prompt treatment with appropriate antibiotics can restore the valve structural integrity with minimal damage. Here we present a series of five cases of culture proven Brucella endocarditis (four native valves, one prosthetic valve) and this report discusses the diagnostic and management issues involved.
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Affiliation(s)
- I Tammi Raju
- Department of Cardiology, Nizam's Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India.
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