Percutaneous devices for the treatment of complex native valve mitral leaflet and aortomitral continuity defects: Review and case series

Right-sided native valve infective endocarditis is common in patients with congenital or valvular heart disease, intracardiac device, central venous catheter and intravenous drug abuse, usually manifesting in adulthood. However, in the absence of predisposing risk factors and in younger age groups, this disease may pose a diagnostic challenge. We report a case series of three juvenile patients with isolated tricuspid valve infective endocarditis without any risk factors and paucity of cardiovascular findings in two of them, in an attempt to highlight the importance of maintaining a high index of suspicion to arrive a timely diagnosis.

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Bioprosthetic tricuspid valve stenosis: a case series

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytz110 ◽

2019 ◽

Vol 3 (3) ◽

Cited By ~ 2

Author(s):

Kazuhito Hirata ◽

Toshiho Tengan ◽

Minoru Wake ◽

Takanori Takahashi ◽

Toru Ishimine ◽

...

Keyword(s):

Valve Replacement ◽

Tricuspid Valve ◽

Venous Pressure ◽

Case Series ◽

Right Heart Failure ◽

Tricuspid Valve Replacement ◽

Native Valve ◽

Late Sequela ◽

High Doses ◽

Tricuspid Valve Stenosis

Abstract Background Bioprosthetic tricuspid valve stenosis is a late sequela of tricuspid valve replacement (TVR); however, detailed information regarding its clinical picture is lacking. Case summary Thirty-one patients with bioprosthetic TVR (mean age: 60.5 ± 16.6 years, male/female: 11/20) were followed-up for 79.5 ± 49.1 months (14–188 months). Eleven patients developed bioprosthetic tricuspid valve stenosis (mean tricuspid gradient >5 mmHg) at a median interval of 96 months (interquartile range: 61–114 months). The mean tricuspid gradient at the time of tricuspid valve stenosis diagnosis was 10.9 ± 3.9 mmHg. Although the mid-term tricuspid valve stenosis-free survival was favourable (92.4% at 60 and 78.7% at 84 months), it had declined steeply to 31.5% by 120 months. Ten out of 11 tricuspid valve stenosis patients showed signs of right heart failure (RHF) as manifested by oedema and elevated jugular venous pressure, requiring moderate-to-high doses of diuretics. Diastolic rumble was audible in 10 patients. Five of the 11 tricuspid valve stenosis patients required redo TVR as a result of refractory RHF. Examination of the five excised bioprostheses showed pannus in four, fusion of the commissure in three, native valve attachment in two, and sclerosis in one. Detailed clinical pictures and pathology of the explanted valves in three cases that underwent surgery are presented in this case series. Discussion Bioprosthetic tricuspid valve stenosis is not uncommon after 8 years. Tricuspid valve replacement performed at the second surgery was associated with a higher incidence of bioprosthetic tricuspid valve stenosis.

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Modified Commando Procedure in Complicated Infective Endocarditis - A Case Series.

10.21203/rs.3.rs-105185/v1 ◽

2020 ◽

Author(s):

Po Sung Chen ◽

Chungyi Chang ◽

Yicheng Chuang ◽

Ichen Chen ◽

Tingchao Lin

Keyword(s):

Infective Endocarditis ◽

Prosthetic Valve ◽

Case Series ◽

Prosthetic Valve Endocarditis ◽

Surgical Mortality ◽

Native Valve ◽

Case Presentation ◽

Native Valve Endocarditis ◽

Fibrous Body ◽

Urgent Surgery

Abstract Background: Complicated infective endocarditis (IE) with perivalvular abscess and destruction of intervalvular fibrous body (IFB) has high mortality risk and requires emergent or urgent surgery mostly. Case presentation: We presented four patients with complicated infective endocarditis combined with perivalvular abscess and IFB destruction. Three patients had prosthetic valve endocarditis and one patient had native valve endocarditis. They all received modified Commando procedure successfully. No surgical mortality or re-exploration for bleeding. Conclusions: We suggest that modified Commando procedure may have some benefit in improving survival rate of patients with complicated IE and reducing complications.

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155. A Case Series of Patients with Gemella Endocarditis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.230 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S103-S104

Author(s):

Abarna Ramanathan ◽

Steven M Gordon ◽

Nabin K Shrestha

Keyword(s):

Heart Valves ◽

Cleveland Clinic ◽

Case Series ◽

Prosthetic Valve Endocarditis ◽

Blood Cultures ◽

Valvular Regurgitation ◽

Native Valve ◽

Duke Criteria ◽

Metastatic Infection ◽

16S Rna

Abstract Background Gemella is a genus of gram-positive bacteria that thrives best at a high partial pressure of CO2 and is an unusual cause of infective endocarditis (IE). Methods We identified cases of Gemella IE in patients aged >18 years old, hospitalized at Cleveland Clinic between July 1, 2007 and January 1, 2017, by screening the Cleveland Clinic IE Registry. Gemella IE was defined as meeting modified Duke Criteria and having Gemella identified as the pathogen (by culture and/or 16S RNA sequencing from explanted valve tissue). Clinical features were obtained by manual chart review. Results A total of 13 cases of Gemella IE (G. haemolysans [6], G. morbillorum [3], G. sanguinis [2], and 2 undifferentiated species) were identified within the study period and accounted for <1% of all cases of IE. 9 were native valve IE and 4 were prosthetic valve endocarditis. Age varied from 20 to 86 years and 77% were male. The most common predisposing factors were pre-existing valvular disease (54%) and congenital heart disease (46%). 3 cases had dental manipulation within the prior 3 months, 3 had bioprosthetic valves, 2 had mechanical heart valves, and 2 were actively using intravenous recreational drugs. All cases were left-sided: 38% involved the aortic valve, 23% the mitral valve and 38% involved both. 69% had positive blood cultures, 38% had positive blood cultures and positive valve PCR, and 31% were identified based on positive valve PCR results only. Not one patient had positive valve cultures. 85% had significant valvular regurgitation and locally invasive disease occurred in 4 patients. Central nervous system emboli occurred in 3 cases and metastatic infection, in the form of lumbar diskitis, in one. All patients were treated surgically and the most commonly used anti-microbials were parenteral ceftriaxone and vancomycin, administered for a median duration of 42 days. All cases survived to hospital discharge and none relapsed over a median follow-up of 2.2 years. Conclusion Gemella species account for less than 1% of cases of IE, with G. haemolysans being the most common species. In a third of cases valve PCR provided the only means of diagnosis. It is effectively treated with surgery and antibiotics. Disclosures All authors: No reported disclosures.

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Modified commando procedure in complicated infective endocarditis ─ a case series

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01480-4 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Posung Chen ◽

Chungyi Chang ◽

Yicheng Chuang ◽

Ichen Chen ◽

Tingchao Lin

Keyword(s):

Infective Endocarditis ◽

Prosthetic Valve ◽

Case Series ◽

Prosthetic Valve Endocarditis ◽

Surgical Mortality ◽

Native Valve ◽

Case Presentation ◽

Native Valve Endocarditis ◽

Fibrous Body ◽

Urgent Surgery

Abstract Background Complicated infective endocarditis (IE) with perivalvular abscess and destruction of intervalvular fibrous body (IFB) has high mortality risk and requires emergent or urgent surgery mostly. Case presentation We presented four patients with complicated infective endocarditis combined with perivalvular abscess and IFB destruction. Three patients had prosthetic valve endocarditis and one patient had native valve endocarditis. They all received modified Commando procedure successfully. No surgical mortality or re-exploration for bleeding. Conclusions We suggest that modified Commando procedure may have some benefit in improving survival rate of patients with complicated IE and reducing complications.

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Infective Endocarditis: A Case Series

Journal of Cardiac Critical Care TSS ◽

10.1055/s-0040-1716610 ◽

2020 ◽

Vol 4 (02) ◽

pp. 156-160

Author(s):

Sarvesh Pal Singh ◽

Dharmraj Singh

Keyword(s):

Infective Endocarditis ◽

Antimicrobial Agents ◽

Case Series ◽

Late Presentation ◽

Native Valve ◽

Native Valve Endocarditis ◽

Endocardial Surface ◽

High Index Of Suspicion ◽

Culture Negative ◽

Atypical Bacteria

AbstractInfective endocarditis (IE) is an infection of the endocardial surface of the heart. The incidence of IE worldwide is approximately 3 to 10 per 100,000 people annually. Twenty percent of patients die during the hospital stay, and the mortality may reach 25 to 30% six months postinfection. We hereby present our experience of six patients, of whom five survived. The cause of one death was late presentation and lack of coverage for Burkholderia in the prescribed empirical antibiotic therapy. One of our patients, with culture-negative endocarditis, responded to doxycycline and did not require any surgery. Five out of six patients who underwent surgery had vegetations more than 10 mm in size, and one patient had an aortic valve abscess (caused by Staphylococcus haemolyticus). Both prosthetic endocarditis and native valve endocarditis can be treated successfully with antimicrobial agents and surgery (when indicated). A high index of suspicion is required to diagnose IE caused by fungus and atypical bacteria.

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