1646 Complicated aortic prosthetic valve endocarditis

Abstract Introduction Prosthetic valve endocarditis (PVE) occurs in 1 to 3% of cases at 1 year and 3 to 9% at 5 years postoperative (PO) with 40% mortality. Clinical complications, uncontrolled infection and agents such as staphylococci and fungi indicate the need for surgery. Recent trial with stable patients (26.7% PVE), oral antibiotic therapy (ATB) proved to be as effect as intravenous antibiotic. However, in complicated cases, prolonged clinical treatment still an exception. Case Report ANFJ, male, 45 years old, aortic valve replacement by mechanical prosthesis in 2015, was hospitalized in Jun/18 with right front-temporal-parietal cerebral hemorrhage and sub febrile for 1 week. Transthoracic echocardiogram (TTE) showed pseudoaneurysm of the mitral valve anterior leaflet with 4+ regurgitation and aortic metallic prosthesis without dysfunction, but transesophageal echocardiogram (TEE) disclosed periprosthetic abscess. Empirical ATB was started until blood cultures yielded S. Agalactiae. After 3 weeks with ceftriaxone, patient persisted sub febrile, high CRP, pulmonary congestion and a new TEE showed mobile aortic prosthesis, fistula and periaortic regurgitation 4+. Urgent surgery was carried out at the same day for abscess drainage and replacement of prosthetic valve by biological aortic prosthesis but without mitral valve approach. Immediate PO underwent with hemodynamic instability, prolonged mechanical ventilation, pleural empyema, acute renal failure requiring dialysis and persistence of fever. Two weeks after surgery, TTE demonstrated new periprosthetic abscess with multiple collections along the ascending aorta. Reassessed by heart team and reoperation was contraindicated due to poor clinical conditions. Patient received parenteral broad-spectrum antibiotic evolving with clinical stabilization, normalization of inflammatory tests becoming afebrile. Aortic angiotomography in Aug/18 showed a periaortic collection of 3.0X2.0X1.9cm and contrast extravasation. New TEE in Aug/18 showed periprosthetic abscess and discrete aortic-right atrium fistula (2+). Maintained ATB until D42, persisting afebrile, negative blood cultures, normal leucogram and CRP. Considered inoperable, he was discharged on Sep/18. After 30 days, patient was stable, negative blood cultures however with worsening ESR (2 -> 99mm/h) and CRP (0.5 -> 15mg/dl). He performed ETT and 18F-FDG PET/CT on Nov/18 with persistence of abscess, fistula and high increase 18F-FDG uptake. Heart team again opted for prolonged oral ATB with amoxicillin 3.0gr/day. Re-evaluated on Dec/18 with laboratory normalization and good clinical evolution until last appointment on April/19 under oral antibiotic. Conclusion Reoperation of PVE improves prognosis, however in some cases where surgical risk is prohibitive, prolonged ATB may be the only option to control infecction or as a bridge for eventual heart transplantation. Abstract 1646 Figure.

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Corynebacterium propinquum: A Rare Cause of Prosthetic Valve Endocarditis

Case Reports in Medicine ◽

10.1155/2016/1391789 ◽

2016 ◽

Vol 2016 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Umair Jangda ◽

Ankit Upadhyay ◽

Farshad Bagheri ◽

Nilesh R. Patel ◽

Robert I. Mendelson

Keyword(s):

Rheumatoid Arthritis ◽

Chest Pain ◽

Mitral Valve ◽

Complete Resolution ◽

Prosthetic Valve ◽

Prosthetic Valve Endocarditis ◽

Blood Cultures ◽

History Of ◽

Systemic Infections ◽

Compromised Patients

NondiphtheriaCorynebacteriumspecies are often dismissed as culture contaminants, but they have recently become increasingly recognized as pathologic organisms. We present the case of a 48-year-old male patient on chronic prednisone therapy for rheumatoid arthritis with a history of mitral valve replacement with prosthetic valve. He presented with fever, dizziness, dyspnea on exertion, intermittent chest pain, and palpitations. Transesophageal echocardiography revealed two medium-sized densities along the inner aspect of the sewing ring and one larger density along the atrial surface of the sewing ring consistent with vegetation. Two separate blood cultures grewCorynebacterium propinquum, which were sensitive to ceftriaxone but highly resistant to vancomycin and daptomycin. The patient completed a course of ceftriaxone and repeat TEE study and after 6 weeks demonstrated near complete resolution of the vegetation. To our knowledge, this case represents the first in the literature ofCorynebacterium propinquumcausing prosthetic valve endocarditis. The ability of these organisms to cause deep-seated systemic infections should be recognized, especially in immune-compromised patients.

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Successful Resolution of Early-Onset Prosthetic Valve Endocarditis Associated With Extended Spectrum β-Lactamases Producing Escherichia coli With Medical Management

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/2324709620965337 ◽

2020 ◽

Vol 8 ◽

pp. 232470962096533

Author(s):

Umaima Dhamrah ◽

Keely Johnson ◽

Aisha Amin ◽

Maurice Policar

Keyword(s):

Escherichia Coli ◽

Mitral Valve ◽

Prosthetic Valve ◽

Prosthetic Valve Endocarditis ◽

Blood Cultures ◽

Extended Spectrum ◽

Successful Resolution ◽

History Of ◽

Valve Placement

A 74-year-old male with a recent bioprosthetic mitral valve placement presented with dyspnea, chills, and palpitations. Blood cultures on admission grew extended spectrum β-lactamase Escherichia coli. Transthoracic echocardiogram and transesophageal echocardiography were negative for valvular vegetations, but given the recent history of mitral valve replacement and difficulty visualizing valvular vegetations in prosthetic valve, we initiated treatment of our patient with antibiotics for 6 weeks. Repeat blood cultures showed clearance of the organism and on follow-up, and the patient had no signs of recurrence of infection.

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Abstract 14789: Multimodality Imaging in Mycobacterium Chimaera Cardiovascular Infections

Circulation ◽

10.1161/circ.142.suppl_3.14789 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Nicholas Y Tan ◽

Alex D Tarabochia ◽

Omar M Abu Saleh ◽

Courtney Bennett

Keyword(s):

Aortic Valve ◽

Prosthetic Valve ◽

Multimodality Imaging ◽

Fluid Collection ◽

Prosthetic Valve Endocarditis ◽

The Other ◽

Aortic Prosthesis ◽

Fdg Uptake ◽

Valve Conduit ◽

Pet Ct

Introduction: Mycobacterium Chimaera (MC) infections following cardiovascular surgery are challenging to diagnose given their insidious presentation. We therefore reviewed the various imaging modalities used to diagnose these infections at Mayo Clinic. Methods: Cases from 01/01/2010-06/01/2020 were identified using electronic medical records. Demographics and clinical history were collected. Imaging studies, including transthoracic echocardiogram (TTE), transesophageal echocardiogram (TEE), positron emission tomography / computed tomography (PET/CT), cardiac CT (CCT), and cardiac magnetic resonance (CMR) were reviewed. Results: A total of 7 patients (85.7% male) were found. 6 underwent aortic valve replacement and 1 received an aortic composite valve conduit. Surgical dates ranged from 01/2010-12/2018. Mean age at presentation was 63.3 years. Mean time from surgery to symptom onset was 28.0 months. All patients underwent TTE and TEE; prosthetic valve endocarditis was identified in 6 cases between both, while CMR established the diagnosis in 1 case. TTE showed prosthetic valve obstruction in 2 cases and an anterior pseudoaneurysm in 1 case. TEE findings included thickened prosthesis and/or vegetations (n=5), thickened posterior root (n=4), and root abscess (n=3). Among the 3 patients who underwent PET/CT, 2 demonstrated increased fluorodeoxyglucose (FDG) uptake around the aortic prosthesis; in addition, 1 had elevated FDG uptake in the myocardium suggesting myocarditis. 1 patient did not have aortic prosthesis FDG uptake. In the 2 patients who had CCT, 1 showed a pseudoaneurysm that prompted suspicion for endocarditis, and the other revealed a fluid collection adjacent to the aortic valve conduit. 2 patients underwent CMR; 1 had aortic prosthesis thickening and patchy areas of myocardial delayed enhancement suspicious for myocarditis, whereas the other showed vegetation and an aortic root abscess. Conclusion: TTE plus TEE successfully identified MC prosthetic valve endocarditis in most cases with TEE having higher specificity. Advanced imaging techniques are helpful to support the diagnosis and assess for myocardial and/or aortic involvement. Combining these modalities is therefore crucial in unveiling this elusive organism.

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Left Ventricular Pseudoaneurysm Repair after Mitral Valve Re-replacement for Prosthetic Valve Endocarditis

Japanese Journal of Cardiovascular Surgery ◽

10.4326/jjcvs.47.166 ◽

2018 ◽

Vol 47 (4) ◽

pp. 166-169

Author(s):

Daisuke Yano ◽

Fumiaki Kuwabara ◽

Shinji Yamada ◽

Shinichi Ashida ◽

Yuichi Hirate

Keyword(s):

Mitral Valve ◽

Prosthetic Valve ◽

Prosthetic Valve Endocarditis ◽

Left Ventricular ◽

Left Ventricular Pseudoaneurysm

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Medically managed prosthetic valve endocarditis caused by Salmonella enteritidis

BMJ Case Reports ◽

10.1136/bcr-2020-237679 ◽

2021 ◽

Vol 14 (6) ◽

pp. e237679

Author(s):

Gavin Connolly ◽

Mita Kale ◽

Andrew Ustianowski

Keyword(s):

Prosthetic Valve ◽

Salmonella Enteritidis ◽

Prosthetic Valve Endocarditis ◽

Good Health ◽

Prosthetic Material ◽

Oral Antibiotic ◽

Rare Occurrence ◽

Combined Surgery ◽

Oral Antibiotic Therapy ◽

Intravenous Antibiotics

Infective endocarditis is associated with morbidity and mortality even when appropriately treated. It can be more complicated to treat when prosthetic material is present, often necessitating surgical revision as well as antimicrobial therapy. Endocarditis caused by gram-negative bacilli is a rare occurrence, with some literature and expert opinion suggesting superior outcomes with combined surgery and antibiotics when a prosthetic valve is involved. In cases where the prosthetic valve is well-functioning and undamaged, or cardiothoracic surgery represents a significant operative risk, it can be unclear how best to proceed. This report documents a case of Salmonella enterica subspecies enterica serovar enteritidis endocarditis of a mechanical mitral valve. The patient was managed with 6 weeks of intravenous antibiotics followed by suppressive oral antibiotic therapy. They remain in good health at 24 months.

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Prosthetic valve endocarditis occurring on a silzone™ coated heart valve used as treatment for rheumatic mitral valve disease

European Journal of Cardio-Thoracic Surgery ◽

10.1016/s1010-7940(01)01081-8 ◽

2002 ◽

Vol 21 (1) ◽

pp. 158-159 ◽

Cited By ~ 1

Author(s):

M Cooper

Keyword(s):

Mitral Valve ◽

Heart Valve ◽

Mitral Valve Disease ◽

Prosthetic Valve ◽

Prosthetic Valve Endocarditis ◽

Valve Disease

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Prosthetic valve endocarditis presenting as meningoencephalitis complicated by pseudo-aneurysms in a remote Aboriginal healthcare setting in Australia: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab265 ◽

2021 ◽

Vol 5 (8) ◽

Author(s):

Anna Louise Watson ◽

Gregory Rice ◽

Tony Hieu Vo ◽

Nadarajah Kangaharan

Keyword(s):

Prosthetic Valve ◽

Prosthetic Valve Endocarditis ◽

Healthcare Setting ◽

Blood Cultures ◽

Fatal Complication ◽

Optimal Care ◽

Australian Aboriginal ◽

Valvular Surgery ◽

Case Summary ◽

History Of

Abstract Background The Australian Aboriginal population has a high burden of cardiac conditions predisposing patients to infective endocarditis. Pseudo-aneurysms are a rare and potentially fatal complication of both prior valvular surgery and endocarditis. Case summary A 31-year-old female with a history of bicuspid aortic valve requiring valve replacement presented with meningoencephalitis. Transoesophageal echo and positive blood cultures for Staphylococcus aureus confirmed prosthetic valve endocarditis (PVE). Aortic root mycotic pseudo-aneurysms developed during antimicrobial therapy and two large pseudo-aneurysms remain post-redo valve, root and arch replacement. Discussion Complications associated with PVE are common, especially due to S. aureus. Redo cardiac surgery is high risk, percutaneous treatments may be technically difficult due to altered post-operative anatomy, and medication adherence issues and lack of healthcare engagement further compromise optimal care in this patient population.

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A modified technique for aortic prosthesis implantation after prosthetic valve endocarditis complicated by complex paraannular aortic abscess

Reviews in Cardiovascular Medicine ◽

10.31083/j.rcm2204168 ◽

2021 ◽

Vol 22 (4) ◽

pp. 1621

Author(s):

Giuseppe Nasso ◽

Nicola Di Bari ◽

Marco Moscarelli ◽

Flavio Fiore ◽

Ignazio Condello ◽

...

Keyword(s):

Prosthetic Valve ◽

Prosthetic Valve Endocarditis ◽

Modified Technique ◽

Prosthesis Implantation ◽

Aortic Prosthesis

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95 A rare case of Lactobacillus Plantarum prosthetic valve endocarditis

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.018 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

A Tavernese ◽

F Caldara ◽

S Muscoli ◽

M Stelitano ◽

G Uccello ◽

...

Keyword(s):

Aortic Valve ◽

Antibiotic Therapy ◽

Lactobacillus Plantarum ◽

Prosthetic Valve ◽

Heart Diseases ◽

Left Ventricular ◽

Blood Cultures ◽

Lactobacillus Species ◽

Oral Antibiotic ◽

Aortic Replacement

Abstract INTRODUCTION Lactobacillus species are rare human pathogens but have been implicated in a variety of infections, including bacteremia and endocarditis, with Lactobacillus casei and Lactobacillus rhamnosus among the most frequently isolated species. Endocarditis due to Lactobacillus represents <0.5% of all cases of endocarditis and are associated with structural heart diseases, recent surgery, extended antibiotic and probiotic use and immuno-deficiency. We report a case of Lactobacillus plantarumendocarditis in a patient with biological aortic prosthetic valve. CASE REPORT Our patient is a 48 year-old male with a past medical history of surgical aortic replacement with a biological prosthetic valve in 2013. He reports the onset of symptoms 4 months before with worsening asthenia. The patient presented to a cardiologist after 3 months from symptoms beginning. A transesophageal echocardiogram (TEE) described marked fibro-plastic thickening of the cusps with two elongated vegetations (12 mm and 7 mm) causing a moderate-to-severe aortic steno-regurgitation. A few days later he came to our emergency department. On admission, the patient was afebrile, eupnoeic on room air. The cardiac examination revealed a regular rate and rhythm with a grade 4 of 6 holosystolic murmur loudest at the aortic and pulmonary focus. Three sets of blood cultures were drawn on admission. Hence, he was transferred to the Infectious Diseases Department where he started antibiotic therapy with Ceftriaxone and Gentamicin. A 18F-FDG PET-CT total body showed tracer accumulation close to the prosthetic aortic valve. Few days later Lactobacillus Plantarum was isolated from blood cultures and, according to the antibiogram results, therapy was adjusted using G Penicillin, Vancomicyn and Gentamicin. The TEE, performed during the hospitalization, showed one mobile vegetation, reduced in size (5 mm), adherent to the anterior aortic cusp, which prolapsed in the left ventricular outflow tract and commissural fusion, causing severe steno-regurgitation (Gmax 84 mmHg, Gmed 54 mmHg). During hospitalization the serial blood cultures resulted negative. Serial TEEs were also performed (3rdand 6thweek), showing a gradual reduction of the cusps thickening and disappearance of commissural fusion (Figure). In the last TEE no vegetations were described, and the transaortic mean gradient was reduced (Gmed 38 mmHg), persisting severe regurgitation. Hence the patient was discharged with oral antibiotic therapy (amoxicillin and clavulanic acid) and indication to redo aortic valve surgery. Written informed consent was obtained. CONCLUSIONS L. plantarum is a rare form of endocarditis. In our patient it caused fibro-plastic thickening of the bioprosthesis cusps and commissural fusion, determining severe steno-regurgitation. It also responded to targeted antibiotic therapy with improvement in cusp mobility but persistence of severe regurgitation. Abstract 95 Figure

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Mitroflow Pericardial Bioprosthesis: Experience to Seven Years

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849239300100305 ◽

1993 ◽

Vol 1 (3) ◽

pp. 123-128 ◽

Cited By ~ 1

Author(s):

W.R. Eric Jamieson ◽

Alfred N. Gerein

Keyword(s):

Mitral Valve ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Prosthetic Valve ◽

Clinical Performance ◽

Prosthetic Valve Endocarditis ◽

Structural Valve Deterioration ◽

Related Mortality

Between 1983 and 1987, the Mitroflow pericardial prosthesis was implanted in 99 patients, ranging in age from 28 to 94 years (mean 62.8 years). Early mortality was 6.1% (6 patients), and late mortality was 4.8% per patient-year (22 patients). Total cumulative follow-up was 458 patient-years (mean 4.6 years). At 7 years, patient survival was 62% for aortic valve replacement and 63% for mitral valve replacement. The overall rate of valve-related complications was 7.4% per patient-year (34 events): thromboembolism, 2.8%; antithromboembolic-relatedhemorrhage, 1.1%; prosthetic valve endocarditis, 0.7%; non-structural dysfunction, 0.7%; and structural valve deterioration, 2.8%. At 7 years, freedom from thromboembolism was 80.3%, and freedom from prosthetic valve endocarditis was 95.5%. At 5 and 7 years, freedom from structural valve deterioration was 93.4% and 69.7%, respectively. At 5 years, freedom from structural valve deterioration was 97.3% for aortic valve replacement (AVR), 86.6% for mitral valve replacement (MVR), and 100% for multiple valve replacement (MR). At 7 years, freedom from structural valve replacement was 84.6% and 61.3% for AVR and MVR, respectively. At 7 years, overall freedom from reoperation was 68.2%; from valve-related mortality, 81.4%; from valve-related residual morbidity, 97.4%; and from treatment failure (valve-related mortality and residual morbidity), 79.0%. At 7 years, the Mitroflow pericardial bioprosthesis has provided satisfactory clinical performance, especially in the aortic position, with an acceptable freedom from structural valve deterioration.

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