scholarly journals P867 Mitral stenosis: from mild to severe in less than a year

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
K Ugedo Alzaga ◽  
R Candina ◽  
A Lambarri ◽  
M Castellanos ◽  
G Aurrekoetxea ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mitral Valve ◽  
Aortic Valve ◽  
Mitral Stenosis ◽  
Prosthetic Valve ◽  
Strong Association ◽  
Clinical Manifestations ◽  
Prosthetic Valve Endocarditis ◽  
Colonic Neoplasm ◽  
Beta Lactam

Abstract We report the case of an 82-year-old woman, with personal history of hypertension, diabetes mellitus, dyslipemia and permanent atrial fibrillation. In 2013 aortic valve substitution surgery was performed with a mechanic prosthetic valve. In her last echocardiogram in May 2018 a mild double mitral lesion was detected, with a normal aortic valve functioning. In March of 2019 she was admitted in hospital with symptoms of heart failure and 38ºC fever. A transthoracic echocardiogram was performed, which revealed a vegetation in the native mitral valve that caused a severe mitral stenosis (area 0.64 cm2). In blood cultures Streptococcus gallolyticycus was isolated. In this situation, a tranesophagical echocardiogram was performed, which confirmed the diagnosis of an infective endocarditis in the native mitral valve. It also showed spontaneous echocontrast as well as a thrombus in the left atrial appendage, despite anticoagulant medication. Given these findings, antibiotic therapy was initiated and surgery programmed. Substitution of the native mitral valve for a biological prosthesis was made. In the transthoracic echocardiographic control the prosthesis was normal functioning. A colonoscopy was performed taking into account the strong association between Streptococcus gallolyticus and colonic lesions, which showed no abnormal findings. At the discharge the patient had no signs or symptoms suggestive of heart failure or infection. Streptococcus gallolytycus is included in the D group of Streptococci. Among hospitalized patients, this group accounts for approximately 5% of streptococcal bloodstream isolates. For humans, the gastrointestinal tract is the most frequent entry point, other potential sources include the hepatobiliary tree and the urinary tract. Clinical manifestations include bacteremia and endocarditis, which is usually highly destructive and frequently bivalvular. Bone infection, meningitis or peritonitis can also be present. Due to the frequent association between this microorganism and colonic neoplasm, colonoscopy is necessary to dismiss pathological findings. Typically D Streptococci can be treated with penicillins, ceftriaxone, carbapenems, vancomycin, daptomycin, and linezolid. The preferred regimen for streptococcal prosthetic valve endocarditis includes a beta-lactam combined with an aminoglycoside, to achieve synergistic effect. Abstract P867 Figure. Mitral stenosis

Mitroflow Pericardial Bioprosthesis: Experience to Seven Years

1993 ◽  
Vol 1 (3) ◽  
pp. 123-128 ◽  
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.

Abstract 14789: Multimodality Imaging in Mycobacterium Chimaera Cardiovascular Infections

Circulation ◽  
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.

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

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

Prosthetic valve endocarditis

ESC CardioMed ◽  
2018 ◽  
pp. 1720-1723
Author(s):  
José A. San Román ◽  
Javier López
Keyword(s):  
Computed Tomography ◽  
Infective Endocarditis ◽  
Antibiotic Treatment ◽  
Prosthetic Valve ◽  
Photon Emission ◽  
Clinical Manifestations ◽  
Prosthetic Valve Endocarditis ◽  
Native Valve ◽  
Native Valve Endocarditis ◽  
Duke Criteria

Prosthetic valve endocarditis (PVE) complicates the clinical course of 1–6% of patients with prosthetic valves and it is one of the types of infective endocarditis with the worst prognosis. In early-onset PVE (that occurs within the first year after surgery), the microbiological profile is dominated by staphylococci. In late-onset PVE, the microorganisms are similar to native valve endocarditis. Clinical manifestations are very variable and depend on the causative microorganism. The diagnosis is established with the modified Duke criteria although they yield lower diagnostic accuracy than in native valve endocarditis. Transoesophageal echocardiography is the main imaging technique in everyday clinical practice in PVE as the sensitivity is higher than transthoracic echocardiography. The findings of other techniques, as cardiac computed tomography (CT), positron emission tomography/CT, or single-photon emission computed tomography/CT have been recently recognized as new major diagnostic criteria and can be very useful in cases with a high level of clinical suspicion and negative echocardiography. Empirical antibiotic treatment should cover the most frequent microorganisms, especially staphylococci. Once the microbiological diagnosis is made, the antibiotic treatment is similar to native valve infective endocarditis, except for the addition of rifampicin in staphylococcal PVE and a longer length (up to 6 weeks) of the treatment. Surgical indications are also similar to native valve endocarditis, heart failure being the most common and embolic prevention the most debatable. Prognosis is bad, and during the follow-up, a team experienced with endocarditis is needed. Patients with a history of PVE should receive antibiotic prophylaxis if they undergo invasive dental manipulations.

scholarly journals A Case of Early Prosthetic Valve Endocarditis Caused by Staphylococcus warneri in a Patient Presenting With Congestive Heart Failure

2017 ◽  
Vol 8 (5) ◽  
pp. 236-240 ◽  
Author(s):  
Maita S. Kuvhenguhwa ◽  
Kevin O. Belgrave ◽  
Sonia U. Shah ◽  
Arnold S. Bayer ◽  
Loren G. Miller
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Prosthetic Valve ◽  
Prosthetic Valve Endocarditis ◽  
Staphylococcus Warneri
Sign in / Sign up

Export Citation Format

Share Document