scholarly journals Venous gangrene of the lower limbs following aortic valve replacement for native valve endocarditis

1998 ◽  
Vol 14 (4) ◽  
pp. 440-442
Author(s):  
Wael I. Awad ◽  
Adam Coumbe ◽  
Robin K. Walesby
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Lower Limbs ◽  
Native Valve ◽  
Native Valve Endocarditis ◽  
Venous Gangrene

scholarly journals P702 An unusual echocardiographic finding of protrusive vegetation caused by perivalvular abscess perforation into the left atrium

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S Suzuki ◽  
Y Takeuchi ◽  
N Hiramatsu ◽  
H Tsuneyoshi ◽  
T Shimada
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Left Atrium ◽  
Valve Replacement ◽  
High Speed ◽  
Unusual Case ◽  
Early Stage ◽  
The Body ◽  
Abscess Formation ◽  
Native Valve

Abstract Background It is well-known that Infective endocarditis (IE) caused by S. aureus progresses rapidly and is highly destructive. The most often abscess formation after aortic valve replacement (AVR) is the mitral-aortic intervalvular fibrosa (MAIVF). It is difficult to cure MAIVF radically once infection occurs, and then the abscess tends to spread. After abscess formation is once established, IE tends to be widespread, the prognosis is definitely poor unless surgical repairment is executed, and then an emergency surgery is essential and unavoidable for complete cure. We report an unusual case of aortic valve abscess with perforation of vegetation into the left atrium after aortic valve replacement. Case report A 77-year-old man underwent the bioprosthetic AVR for aortic valve stenosis one month ago. On the 9th day after discharge, he visited the hospital for the follow-up. At the time, the body temperature was 36.6 ° C, the blood pressure 133/50 mmHg, white blood cell count 10500/μL, and C-reactive protein 3.31 mg/dL. Transthoracic echocardiography (TTE) demonstrated the perivalvular abscesses on the prosthetic aortic valve and mass structures attached to the MAIVF in the left atrium (Figure A, C). He was hospitalized again and had an emergency re-operation. Intraoperative transesophageal echocardiography (TEE) showed a perivalvular abscess on the prosthetic valve, and a high-intensity structure (vegetation like) protruding from the Valsalva Sinus into the left atrium of the MAIVF (Figure B, D). Surgical findings did not reveal any wart on the native valve itself. One-third of the annulus was disrupted. The subvalvular tissue all around was abscessed. Notably, the abscess cavity between NCC and LCC reached MAIVF of the anterior mitral leaflet, and the structure projecting to the left atrium was vegetation. In this case, TTE pointed out a perivalvular abscess of the aortic valve, IE was suspected at the time of outpatient visit at an early stage after discharge, and the spread of inflammation was observed with a high speed beyond the expectation at the time of operation. Conclusion Early after the operation, TTE revealed a mass was protruded into the left atrium. Generally, vegetation is soft and flexible in itself. However, in this case, the vegetation was less mobile, and for that reason, abscesses or tumors were suspected. TEE enabled us to obtain anatomically more detailed information and to foresee the left atrial wall repairment at the time of reoperation. We reported an unusual case of IE with solid vegetation attached to the wall and difficult to diagnose. Abstract P702 Figure.

Surgical explantation of a failed transcatheter aortic valve

2021 ◽  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Lower Risk ◽  
Transcatheter Aortic Valve Replacement ◽  
Surgical Aortic Valve Replacement ◽  
Native Valve ◽  
Transcatheter Aortic Valve ◽  
Structural Deterioration ◽  
Structural Valve Deterioration

With transcatheter aortic valve replacement being increasingly utilized in a younger and lower risk population, we can expect to see larger numbers of patients presenting with structural deterioration of aortic valves replaced by the transcatheter route that now require explantation and surgical replacement. Surgical aortic valve replacement after transcatheter aortic valve replacement is associated with operative morbidity and mortality rates significantly higher than those seen in the setting of surgical replacement of the native valve, which had a 30-day mortality of 12–20% in recent series. Centers performing transcatheter aortic valve replacement in lower risk patients with longer expected lifespans and a higher probability of late structural deterioration of the transcatheter aortic valve replacement should carefully consider their choice of valve type (balloon-expandable versus self-expanding) and patient anatomy, including annulus and root diameter, at the time of the initial valve intervention. Further, one should not forget the mechanical surgical aortic valve replacement option in younger patients with risk factors for early structural valve deterioration such as obesity, metabolic syndrome, and chronic kidney disease. The objectives of this tutorial are to describe the preoperative workup for a patient with late structural valve deterioration after transcatheter aortic valve replacement, detail the explantation approach specific to self-expanding valves, and illustrate the key decisions and techniques needed for subsequent surgical aortic valve replacement.

scholarly journals Recurrent Primary Cardiac Lymphoma on Aortic Valve Allograft: Implications for Therapy

2014 ◽  
Vol 41 (5) ◽  
pp. 543-546 ◽  
Author(s):  
Fahmi J. Farah ◽  
Christopher D. Chiles
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
B Cell ◽  
Valve Replacement ◽  
Cell Lymphoma ◽  
Tumor Resection ◽  
B Cell Lymphoma ◽  
Native Valve ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Primary malignant cardiac lymphomas associated with grafts are extremely rare: to our knowledge, only 6 cases of prosthesis-associated B-cell lymphoma have been reported. Ours is the first report of recurrent diffuse large B-cell lymphoma associated with aortic valve allografts. We treated a 60-year-old man who presented in early 2007 with aortic valve endocarditis. He underwent aortic valve replacement with an allograft; the resected native valve showed active endocarditis without tumor. In January 2011, the patient underwent repeat aortic valve replacement because of symptomatic aortic regurgitation. The explanted valve specimen displayed diffuse large B-cell lymphoma. In September 2011, the patient presented with fever and a mass around the aortic valve. He died in January 2012. On autopsy, the explanted replacement valve displayed recurrent diffuse large B-cell lymphoma. The recurrent lymphoma on a new graft leads us to believe that this tumor is more aggressive than had been thought. We propose early systemic chemotherapy, in addition to tumor resection, for the possibility of a better prognosis. We discuss our patient's case and review the relevant medical literature.

scholarly journals Mechanical versus biological valve prosthesis for surgical aortic valve replacement in patients with infective endocarditis

2019 ◽  
Vol 29 (3) ◽  
pp. 386-392 ◽  
Author(s):  
Ville Kytö ◽  
Elina Ahtela ◽  
Jussi Sipilä ◽  
Päivi Rautava ◽  
Jarmo Gunn
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Ischaemic Stroke ◽  
Valve Replacement ◽  
Major Bleeding ◽  
Valve Prosthesis ◽  
Surgical Aortic Valve Replacement ◽  
Native Valve ◽  
Mechanical Prostheses ◽  
Biological Prostheses

Abstract OBJECTIVES The optimal choice of valve prosthesis in surgical aortic valve replacement for infective endocarditis (IE) is controversial. We studied outcomes after mechanical versus biological prosthetic valve surgical aortic valve replacement in IE patients. METHODS All patients with native-valve IE aged 16–70 years undergoing mechanical or biological surgical aortic valve replacement in Finland, between 2004 and 2014, were retrospectively studied (n = 213). Outcomes were all-cause mortality, ischaemic stroke, major bleeding and aortic valve reoperation at 1 year and 5 years. Results were adjusted for baseline features (age, sex, comorbidity burden, atrial fibrillation, valvular stenosis, concomitant coronary artery bypass grafting, extension, urgency, year and centre of operation). Median follow-up was 5 years. RESULTS The 5-year mortality rate was 19.0% with mechanical prostheses and 34.8% with biological prostheses [hazard ratio (HR) 0.47, 95% confidence interval (CI) 0.23–0.92; P = 0.03]. Ischaemic stroke rates were 8.3% with mechanical prostheses and 16.8% with biological prostheses at 5 years (HR 0.21, CI 0.06–0.79; P = 0.01). Results were comparable in patients aged 16–59 and 60–70 years (interaction P = 0.84). Major bleeding within 5 years was similar between mechanical (11.3%) and biological valve (13.4%) groups (P = 0.95) with comparable rates of both gastrointestinal and intracranial bleeds. Reoperation rates at 5 years were 5.0% for mechanical prostheses and 9.2% for biological prostheses (P = 0.14). The 1-year ischaemic stroke rate was lower with mechanical prostheses (3.6% vs 11.6%, P =0.03), whereas mortality, major bleeding and reoperation rates were similar between groups. CONCLUSIONS The use of mechanical aortic valve is associated with lower mid-term mortality compared to biological prosthesis in patients with native-valve IE aged ≤70 years. Our results do not support the routine choice of a biological aortic valve prosthesis in this patient group.

scholarly journals Surgical Outcomes in Native Valve Infectious Endocarditis: The Experience of the Cardiovascular Surgery Clinic – Cluj-Napoca Heart Institute

2015 ◽  
Vol 88 (3) ◽  
pp. 338-342 ◽  
Author(s):  
Adrian Molnar ◽  
Ioan Muresan ◽  
Catalin Trifan ◽  
Dana Pop ◽  
Diana Sacui
Keyword(s):  
Mitral Valve ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Mitral Valve Repair ◽  
Mechanical Valve ◽  
Infectious Endocarditis ◽  
Valve Repair ◽  
Native Valve

Background and aims. The introduction of Duke’s criteria and the improvement of imaging methods has lead to an earlier and a more accurate diagnosis of infectious endocarditis (IE). The options for the best  therapeutic approach and the timing of surgery are still a matter of debate and require a close colaboration between the cardiologist, the infectionist and the cardiac surgeon.Methods. We undertook a retrospective, descriptive study, spanning over a period of five years (from January 1st, 2007 to December 31st, 2012), on 100 patients who underwent surgery for native valve infectious endocarditis in our unit.Results. The patients’ age varied between 13 and 77 years (with a mean of 54 years), of which 85 were males (85%). The main microorganisms responsible for IE were: Streptococcus Spp. (21 cases – 21%), Staphylococcus Spp. (15 cases – 15%), and Enterococcus Spp. (9 cases – 9%). The potential source of infection was identified in 26 patients (26%), with most cases being in the dental area (16 cases – 16%). The lesions caused by IE were situated in the left heart in 96 patients (96%), mostly on the aortic valve (50 cases – 50%). In most cases (82%) we found preexisting endocardial lesions which predisposed to the development of IE, most of them being degenerative valvular lesions (38 cases – 38%). We performed the following surgical procedures: surgery on a single valve - aortic valve replacement (40 cases), mitral valve replacement (19 cases), mitral valve repair (1 case), surgery on more than one valve – mitral and aortic valve replacement (20 cases), aortic and tricuspid valve replacement (1 case), aortic valve replacement with a mechanical valve associated with mitral valve repair (5 cases), aortic valve replacement with a biological valve associated with mitral valve repair (2 cases), and mitral valve replacement with a mechanical valve combined with De Vega procedure on the tricuspid valve (1 case). In 5 patients (5%) the bacteriological examination of valve pieces excised during surgery was positive. In 3 cases it matched the germ identified in the hemocultures, and in 2 cases it evidenced another bacterium.Conclusion. The overall mortality of 5% is well between the limits presented in literature, being higher (30%) in patients who required emergency surgery. For the patients who return into our clinic with prosthetic valve endocarditis, the mortality after surgery was even higher (50%). 

scholarly journals Totally endoscopic aortic valve replacement with stented biological and mechanical aortic prostheses

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Pitsis ◽  
N Tsotsolis ◽  
N Nikoloudakis ◽  
H Boudoulas ◽  
K.D Boudoulas
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Aortic Root ◽  
The Other ◽  
Paravalvular Leak ◽  
Native Valve ◽  
Mechanical Prostheses ◽  
The Mean ◽  
Pacemaker Insertion

Abstract Background Endoscopic mitral valve surgery has become the gold standard of care in many expert centres around the globe. The aortic valve has not met the same popularity mainly due to the very confined space in the aortic root, and to the close proximity with the sternum which restricts the movement of the endoscopic instruments. When endoscopic aortic valve replacement is practiced in expert centres, is usually performed with the use of sutureless bioprostheses. We hereby present our experience of totally endoscopic aortic valve replacement (TEAVR) with conventional mechanical and biological prostheses. Methods Since January 2019, fifty-two consecutive patients with significant aortic stenosis and/or aortic regurgitation, who were operated with TEAVR with conventional prostheses were studied. 7,69% of the cases were REDOs. The prostheses used were either stented bovine pericardial in 84,6% of the patients and bileaflet mechanical in 15,4%. The operations were performed through a 3 to 4 cm working incision in the 3rd intercostal space (ICS) right parasternally (where an extra small soft tissue protector was deployed), a 10 mm port for the 3D, 30°, endoscope, and a 5 mm port for the left atrial vent. On full cardiopulmonary bypass, the heart was arrested with cardioplegia which was administered either in the aortic root or directly in the coronary ostia. A transverse aortotomy was performed 3 cm above the right coronary ostium. The native valve (tricuspid or bicuspid) was excised, the annulus was sized and the prostheses were inserted using twelve to fifteen annular sutures who were secured using an automated suture-fastening device. In order to facilitate exposure in the aortic root, a metal self-expandable net was used. Results The average age of the patients treated was 68,3 years (range 36–81, median 72). The mean EuroSCORE2 was 3,22 (0,9–12,01, SEM:0,71). The mean size of the prostheses inserted was 23,72 mm (21–27, median 23) and the mean postoperative peak gradient was 12,15 (5–19, SEM: 1,00). Mean cross clamp and CPB times were 75,38 min (SEM:5,87) and 116,30 (SEM:8,63). There was no case of paravalvular leak or pacemaker insertion. There was no mortality in this cohort of patients. There was one case of cerebrovascular accident. Conclusions TEAVR can be performed safely with conventional aortic prostheses. There are several advantages of the technique over the other aortic valve replacing approaches. Over the other surgical techniques has the advantage of not fracturing the sternum or spreading or dislodging the ribs and increased patient satisfaction. Over the TAVI has the advantages of fully removing the diseased native valve, securing the prosthesis at the exact annular level without any paravalvular leaks or need for pacemaker insertion and the ability of using mechanical prostheses. The main disadvantages of the technique are the relatively prolonged cross clamp and CPB times and the steep learning curve. TEAVR Funding Acknowledgement Type of funding source: None

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