scholarly journals P639 Dehiscence of Bio-Bentall aortic graft after repeated staphylococcus aureus infective endocarditis

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Ovsenik ◽  
T Klokocovnik ◽  
M Cercek ◽  
S Frljak ◽  
M Bervar
Keyword(s):  
Staphylococcus Aureus ◽  
Coronary Artery ◽  
Infective Endocarditis ◽  
Aortic Valve ◽  
Right Coronary Artery ◽  
Prosthetic Valve ◽  
Ascending Aorta ◽  
Bentall Procedure ◽  
History Of

Abstract Introduction Echocardiography is the primary imaging modality in prosthetic valve endocarditis (PVE). It is characterised by a lower incidence of vegetations and a higher incidence of perivalvular complications, including valve dehiscence and must be suspected in case of a new periprosthetic regurgitation, even without vegetation or abscess. Multimodality approach is mandatory to detect penetration of the process into the valve ring, aortic root or ascending aorta for complete operative preparation. Case presentation A 22-year old male, with history of Bio-Bentall procedure due to Staphylococcus aureus (S.aureus) infective endocarditis on the mechanical aortic valve (AV) two years priorly, presented to the emergency department with sudden dyspnea without fever. He was treated for pneumonia due to increased inflammatory parameters and bilateral pulmonary infiltrates on X-Ray. Due to complete regression of infiltrates over the night, transthoracic echocardiography (TTE) was performed, revealing almost complete dehiscence of the AV graft with most of the antegrade and retrograde flow through the pseudoaneurismatic sac, communicating with the ascending aorta at the distal graft dehiscence, no clear vegetation was seen. With clearly visible valve and supravalvular pathology of the AV on TTE, we proceeded to computed tomography angiography (CTA) of the thoracic aorta, which showed dissection and delineated rupture of Bio-Bentall graft. The pseudoaneurismatic sac surrounding bulbar portion of Bentall graft, communicating with the left outflow tract and sinus Valsave was seen, compressing ostial portion of the left main and right coronary artery. Re-Bio-Bentall procedure and venous grafting of the left anterior descendant and right coronary artery were performed. Intraoperative transthoracic transesophageal echocardiography (TEE) confirmed the findings, already provided by TTE and CTA. Hemocultures as well as sonication of the removed graft remained negative for bacteria. Postoperatively, left ventricular failure developed, requiring VA ECMO. On postoperative CTA, changes were consistent with usual postprocedural changes. After prolonged rehabilitation, the patient was released home, clinically stable, but with severely reduced ejection fraction of the left ventricle, severe diastolic dysfunction and mild mitral regurgitation. Conclusion TTE is a very useful, non-invasive imaging method in diagnosing PVE and its complications, which can be upgraded with TEE or CTA to provide additional information on the ascending aorta. In a patient, with the past history of repetitive S. aureus infective endocarditis, presenting with Bio-Bental dehiscence, PVE cannot be excluded completely. Even though the timing for follow-up imaging is not well defined in current guidelines, patients with dehiscence of prosthetic valve or graft present a high risk group, demanding individual follow-up planning and lower threshold for imaging referral. Abstract P639 Figure. Dehiscence of aortic valve graft

Infective endocarditis in patients who use IV drugs: a single centre cohort

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H Alraddadi ◽  
A Alsagheir ◽  
S Gao ◽  
K An ◽  
H Hronyecz ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Infective Endocarditis ◽  
Long Term Outcomes ◽  
Replacement Surgery ◽  
Short Term Mortality ◽  
History Of ◽  
Short And Long Term ◽  
Baseline Characteristics

Abstract Background Managing endocarditis in intravenous drug use (IVDU) patients is challenging: unless patients successfully quit IVDU, the risk of re-infection is high. Clinicians often raise concerns with ethical and resource allocation principles when considering valve replacement surgery in this patient population. To help inform practice, we sought to determine the long-term outcomes of IVDU patients with endocarditis who underwent valve surgery in our center. Method After research ethics board approval, infective endocarditis cases managed surgically at our General Hospital between 2009 and 2018 were identified through the Cardiac Care Network. We reviewed patients' charts and included those with a history of IVDU in this study. We abstracted data on baseline characteristics, peri-operative course, short- and long-term outcomes. We report results using descriptive statistics. Results We identified 124 IVDU patients with surgically managed endocarditis. Mean age was 37 years (SD 11), 61% were females and 8% had redo surgery. During admission, 45% (n=56) of the patients had an embolic event: 63% pulmonary, 30% cerebral, 18% peripheral and 11% mesenteric. Causative organisms included Methicillin-Sensitive Staphylococcus Aureus (51%, n=63), Methicillin-Resistant Staphylococcus Aureus (15%, n=19), Streptococcus Viridans (2%, n=2), and others (31%, n=38). Emergency cardiac surgery was performed for 42% of patients (n=52). Most patients (84%) had single valve intervention: 53% tricuspid, 18% aortic and 13% mitral. Double valve interventions occurred in 15% (n=18). Overall, bioprosthetic replacement was most commonly chosen (79%, n=98). In-hospital mortality was 7% (n=8). Median length of stay in hospital was 13 days (IQR 8,21) and ICU 2 days (IQR 1,6). Mortality at longest available follow-up was 24% (n=30), with a median follow-up of 129 days (IQR 15,416). Valve reintervention rate was 11% (n=13) and readmission rate was 14% (n=17) at a median of 275 days (IQR 54,502). Conclusion Despite their critical condition, IVDU patients with endocarditis have good intra-hospital outcomes. Challenges occur after hospital discharge with loss of follow-up and high short-term mortality. IVDU relapse likely accounts for some of these issues. In-hospital and community comprehensive addiction management may improve these patients' outcomes beyond the surgical procedure. Annual rate 2009–2018 Funding Acknowledgement Type of funding source: None

Dynamic kinking of right coronary artery after the button Bentall procedure

2021 ◽  
Vol 14 (1) ◽  
pp. e239128
Author(s):  
Tomoki Fukui ◽  
Nobuyuki Ogasawara ◽  
Shinji Hasegawa
Keyword(s):  
Coronary Artery ◽  
Right Coronary Artery ◽  
Multidetector Ct ◽  
Coronary Intervention ◽  
Drug Eluting Stent ◽  
Sinus Of Valsalva Aneurysm ◽  
Bentall Procedure ◽  
Percutaneous Coronary ◽  
Drug Eluting

Postoperative coronary artery complications after Bentall procedures are well recognised but are rare and potentially fatal. There have been only five cases documenting percutaneous coronary intervention (PCI) for right coronary artery (RCA) involvements after button Bentall procedures. We describe a case of postoperative silent myocardial ischaemia in a 72-year-old man who underwent the button Bentall procedure for a right sinus of Valsalva aneurysm. On postoperative day 15, an RCA complication was incidentally detected by follow-up multidetector CT. Coronary angiography showed proximal RCA kinking, which was not an anastomosis but a native coronary artery. The patient underwent a successful PCI with drug-eluting stent implantation. We reviewed six cases consisting of this case and five previous cases treated with PCI. These cases enhance the recognition of potential RCA complications after the button Bentall procedure.

Abstract 14160: Transcatheter Aortic Valve Replacement Associated Infective Endocarditis: Comparison of Early, Intermediate and Late Onset Cases

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Simrat Kaur ◽  
Gursharan Samra ◽  
Manpreet Kaur ◽  
Nabin Shrestha ◽  
Steven Gordon ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Infective Endocarditis ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Late Onset ◽  
Transcatheter Aortic Valve ◽  
Common Organism

Introduction: Transcatheter aortic valve replacement associated infective endocarditis (TAVR-IE) is a relatively rare complication of TAVR. Little is known about the characteristics of early, intermediate versus late onset TAVR-IE. Methods: We studied the risk factors, microbiological patterns, diagnostic and treatment strategies in patients with early (<60 days), intermediate (60-365 days) and late onset (>1 year) TAVR-IE. Results: Ten out of 494 definite cases of prosthetic valve IE between 2007 and 2019, were confirmed to have TAVR-IE from the IE registry at our center. The mean age was 78.1 ± 13.7 years, with 50% being female. Most (90%) TAVR procedures were performed via transfemoral route, and one underwent transapical TAVR. Baseline comorbidities were common, with mean BMI 33.1 ± 5.5 kg/m2, diabetes and hypertension in 60% and chronic kidney disease in 50% of cases. Mean STS risk score was 7.8 ± 5.7. Most (60%) TAVR-IE cases had intermediate onset, with Staphylococcus aureus being the most common organism (66.6%). Diagnostic modalities and complications are described in Table 1. Two cases had early onset TAVR-IE, one of which was due to Pseudomonas aeruginosa, and underwent successful surgical treatment. Late onset TAVR-IE was observed in 20% of cases. 18-fluorodeoxyglucose positron emission tomography (18-FDG-PET) aided in diagnosis of TAVR-IE in 20% of cases. Mortality due to IE was observed in 40% of cases. Most of the patients underwent conservative management, and 37.5% survived over a mean follow up of 709 ± 453 days. Two patients underwent surgery, of whom one died day 30 post-operatively from sepsis. Mortality due to IE occurred in 25% of cases in the early and intermediate onset groups, while there was 100% mortality in the late onset group. Conclusions: In a single-center cohort, most TAVR-IE cases had an intermediate onset, with Staphylococcus aureus being the most common organism. Late onset TAVR-IE was associated with higher mortality at follow-up.

scholarly journals ST segment elevation caused by ostial right coronary artery obstruction in infective endocarditis: a case report

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Alexander Bolton ◽  
Georges Hajj ◽  
Laila Payvandi ◽  
Christopher Komanapalli
Keyword(s):  
Coronary Artery ◽  
Infective Endocarditis ◽  
Aortic Valve ◽  
Right Coronary Artery ◽  
Tertiary Care ◽  
Care Facility ◽  
Coronary Syndrome ◽  
St Segment ◽  
Coronary Embolization ◽  
The Right

Abstract Background Acute coronary syndrome (ACS) is a rare, but serious complication of infective endocarditis, and diagnosis can be challenging given clinical overlap with other syndromes. A rare cause of ACS in infective endocarditis is mechanical obstruction of the coronary artery. We present the case of a patient with infective endocarditis who developed ST segment myocardial infarction due to occlusion of the right coronary artery ostium by a vegetation. Case presentation A 53-year-old female with no prior history of coronary artery disease was transferred to our tertiary care facility for evaluation and treatment of suspected myopericarditis. After transfer she developed inferior ST segment elevations on ECG along with fever and positive blood cultures for methicillin susceptible Staphylococcus aureus (MSSA). A transesophageal echocardiogram revealed a vegetation on the aortic valve that intermittently prolapsed into the right coronary ostium. She decompensated from a hemorrhagic brain infarct and subsequently transferred to the intensive care unit. She underwent surgical aortic valve debridement without prior cardiac catheterization given the danger of septic coronary embolization. After a prolonged hospital course with multiple complications, she was able to discharge home, with no neurologic deficits on follow-up. Conclusions ACS presents a diagnostic and therapeutic challenge in the setting of infective endocarditis. Careful attention to the history, physical exam and testing can help differentiate infective endocarditis from other conditions sharing similar symptoms. Traditional atherosclerotic ACS management may cause great harm when treating patients with infective endocarditis. The presence of a multidisciplinary endocarditis team is ideal to provide the best clinical outcomes for this population.

scholarly journals Aortic Valve Endocarditis Complicated by ST-Elevation Myocardial Infarction

2014 ◽  
Vol 41 (6) ◽  
pp. 668-670 ◽  
Author(s):  
Benjamin E. Jenny ◽  
Yassar Almanaseer
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Infective Endocarditis ◽  
Aortic Valve ◽  
Right Coronary Artery ◽  
Medical Literature ◽  
Abscess Formation ◽  
Clinical Event ◽  
St Elevation ◽  
The Right

Infective endocarditis complicated by abscess formation and coronary artery compression is a rare clinical event with a high mortality rate, and diagnosis requires a heightened degree of suspicion. We present the clinical, angiographic, and echocardiographic features of a 73-year-old woman who presented with dyspnea and was found to have right coronary artery compression that was secondary to abscess formation resulting from diffuse infectious endocarditis. We discuss the patient's case and briefly review the relevant medical literature. To our knowledge, this is the first reported case of abscess formation involving a native aortic valve and the right coronary artery.

scholarly journals A rare case of bacterial infective endocarditis caused by Streptococcus alactolyticus

2019 ◽  
Vol 3 (Issue 3) ◽  
pp. 109
Author(s):  
Nedim Cekmen ◽  
Oben Baysan ◽  
Emine Disbudak ◽  
Ceren Gunt
Keyword(s):  
Intensive Care Unit ◽  
Infective Endocarditis ◽  
Aortic Valve ◽  
Rare Case ◽  
Artery Bypass ◽  
Previous History ◽  
Blood Cultures ◽  
Bypass Grafting ◽  
History Of

Background: Streptococcus alactolyticus is a rarely isolated bacterium, which classified under DNA cluster IV of the S. Bovis/S. equinus complex. Infections, especially infective endocarditis, caused by Strep. alactolyticus are very rare in humans. Case Report: We describe a case of Strepotoccocus alactolyticus bacteriemia complicated by infective endocarditis. A 64-year-old male with a previous history of coronary artery bypass grafting applied to our cardiology outpatient clinic with complaints of dyspnea, fever, confusion and an apical holosystolic murmur. He was admitted to the intensive care unit. Transthoracic and transesophageal echocardiography showed the presence vegetation on the aortic valve. S. alactolyticus was detected on serial blood cultures. The patient was first treated with intensive antimicrobial therapy, and then underwent mitral and aortic valve replacements with uneventful follow-up. Conclusion: Streptococcus alactolyticus infective endocarditis has only been reported previously in one patient. More information is certainly needed for diagnosis and treatment of patients infected with Streptococcus alactolyticus. Key words: Streptococcus alactolyticus, endocarditis

scholarly journals Mechanical Prosthetic Valve Sparing for Aortic Root Abscess Complicated by Infective Endocarditis

2020 ◽  
Vol 47 (4) ◽  
pp. 280-283
Author(s):  
Ahmed Ahmed ◽  
Ayman Ammar ◽  
Yasser Elnahas ◽  
Mohammed Abd Al Jawad
Keyword(s):  
Infective Endocarditis ◽  
Aortic Valve ◽  
Aortic Root ◽  
Prosthetic Valve ◽  
Paravalvular Leak ◽  
Mechanical Aortic Valve ◽  
Aortic Root Abscess ◽  
Mechanical Prosthetic Valve ◽  
Valve Sparing

Aortic root abscess complicated by infective endocarditis of a mechanical prosthetic valve is associated with morbidity and death. We retrospectively report our experience with a valve-sparing technique for managing this condition. From October 2014 through November 2017, 41 patients at our center underwent surgery for aortic root abscess complicated by infective endocarditis of a mechanical prosthetic valve. Twenty (48.7%) met prespecified criteria for use of our valve-sparing technique after careful assessment of the mechanical valve and surrounding tissues. Our technique involved draining the abscess, aggressively débriding all infected and necrotic tissues, and then repairing the resulting defect by suturing a Gelweave patch to the healthy aortic wall and to the cuff of the valve. We successfully preserved the mechanical aortic valve in all 20 patients. Two (10%) died early (≤30 d postoperatively) of low cardiac output syndrome with progressive heart failure, superadded septicemia, and multisystem organ failure. At 1-year follow-up, the 18 surviving patients (90%) were symptom free and had a well-functioning mechanical aortic valve with no paravalvular leak. We conclude that, in certain patients, our technique for managing aortic root abscess and sparing the mechanical aortic valve is a safe and less time-consuming approach with relatively low mortality and encouraging midterm follow-up outcomes.

scholarly journals Anomalous Right Coronary Artery Arising from the Pulmonary Artery with Associated Enlargement of the Left Coronary Artery: A Case Report

2021 ◽  
Vol 24 (2) ◽  
pp. E293-E295
Author(s):  
Yueqiu Su ◽  
Zhongze Cao ◽  
Yunfei Ling ◽  
Yong jun Qian
Keyword(s):  
Coronary Artery ◽  
Pulmonary Artery ◽  
Right Coronary Artery ◽  
Left Coronary Artery ◽  
Female Child ◽  
Ascending Aorta ◽  
Coronary Anomalies ◽  
The Right ◽  
Congenital Coronary Anomalies

An anomalous right coronary artery arising from the pulmonary artery (ARCAPA) is among the least common form of congenital coronary anomalies, accounted for the incidence of only 0.002% in the general population. Most ARCAPA patients have no symptoms but may develop myocardial ischemia. Surgical correction of the anomaly is recommended to prevent subsequent fatal outcomes. Here, we reported a case of a 2-year-old female child initially hospitalized for diarrhea, but later diagnosed with an ARCAPA through echocardiogram and computed tomography. Surgical reimplantation of the right coronary artery from the pulmonary artery to the ascending aorta was performed. The patient recovered well from the surgery with no postoperative complications. In the follow-up assessments, normal coronary function and myocardial effusion were demonstrated.

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