scholarly journals Infective endocarditis complicating COVID-19 pneumonia: a case report

2020 ◽  
Author(s):  
Enrico Guido Spinoni ◽  
Anna Degiovanni ◽  
Francesco Della Corte ◽  
Giuseppe Patti
Keyword(s):  
Infective Endocarditis ◽  
Transoesophageal Echocardiography ◽  
Healthcare Personnel ◽  
Icu Stay ◽  
First Case ◽  
Valve Function ◽  
Line Imaging ◽  
Coronary Cusp ◽  
Valvular Lesion ◽  
High Degree

Abstract Background During the COVID-19 outbreak, cardiovascular imaging, especially transoesophageal echocardiography (TOE), may expose healthcare personnel to virus contamination and should be performed only if strictly necessary. On the other hand, transthoracic echocardiography (TTE) and TOE represent the first-line imaging exams for the diagnosis of infective endocarditis (IE). To date, this is the first case of COVID-19 complicated by IE. Case summary We present the case of a 57-year-old man with severe COVID-19 pneumonia requiring mechanical ventilation. During the intensive care unit (ICU) stay, he developed fever and positive haemocoltures for methicillin-resistant Staphylococcus aureus infection. TTE did not identify endocardial vegetations. TOE was then performed and outlined IE of the aortic valve on the non-coronary cusp. Antibiotic therapy was given with progressive resolution of the septic state and improvement of inflammatory signs. After 30 days of ICU stay, the patient was transferred to the Sub-ICU and then to a rehabilitation hospital. A close follow-up has been scheduled: after full recovery, a new echocardiography will be performed (TTE and TOE, if the former is non-conclusive) to consider surgical valve repair in the case of persistence/progression of the valvular lesion or deterioration of the valve function. Discussion In COVID-19 patients, echocardiography remains the leading imaging exam for the diagnosis of IE. If the suspicion of IE is high, even in this setting of patients, TTE or TOE (if TTE is non-conclusive) are mandatory. A high degree of attention must be paid and appropriate preventive measures taken to avoid contamination of healthcare personnel.

scholarly journals Intraoperative diagnosis of mitral valve endocarditis secondary to Paenibacillus provencensis

2017 ◽  
Vol 99 (2) ◽  
pp. e54-e55 ◽  
Author(s):  
A-C Pinho-Gomes ◽  
A Nasir ◽  
R Mosca ◽  
S Mirza ◽  
I Kadir
Keyword(s):  
Infective Endocarditis ◽  
Mitral Valve ◽  
Aortic Valve ◽  
Gene Sequencing ◽  
Transoesophageal Echocardiography ◽  
16S Rdna Gene ◽  
Intraoperative Diagnosis ◽  
First Case ◽  
Mitral Valve Vegetation ◽  
16S Rdna Gene Sequencing

We report the first case of infective endocarditis caused by Paenibacillus provencensis. A mitral valve vegetation was incidentally discovered by intraoperative transoesophageal echocardiography in a 70-year-old woman undergoing aortic valve replacement. The precise identification of the causative agent was by means of genotypic characterisation with 16S rDNA gene sequencing. The patient was successfully treated with a 6-week course of antibiotics postoperatively, following debridement of the valve vegetation.

scholarly journals Infective endocarditis of an aortic bioprosthesis causing life-threatening incessant junctional tachycardia: a case report

2020 ◽  
Author(s):  
Quentin Chatelain ◽  
Andrea Carcaterra ◽  
Florian Rey ◽  
Haran Burri
Keyword(s):  
Case Report ◽  
Infective Endocarditis ◽  
Aortic Valve ◽  
Electrophysiological Study ◽  
Atrioventricular Node ◽  
Transoesophageal Echocardiography ◽  
Junctional Ectopic Tachycardia ◽  
First Case ◽  
Intravenous Amiodarone ◽  
The Right

Abstract Background  Infective endocarditis with paravalvular abscess can be complicated by atrioventricular block (AVB), but junctional ectopic tachycardia (JET) has as yet never been described. Case summary  A 68-year-old male recently admitted with Staphylococcal aureus endocarditis of his aortic valve bioprosthesis, presented with a regular tachycardia at 240 b.p.m. with a pre-existent right bundle branch block pattern. Haemodynamic collapse necessitated electrical cardioversion, following which high-grade AVB was observed. Multiple recurrences of the same tachycardia required repeated electrical cardioversions and emergent electrophysiological study, which indicated JET. The tachycardia was unresponsive to overdrive pacing, adenosine and intravenous amiodarone, and external cardioversions. Radiofrequency catheter ablation of the atrioventricular node was performed emergently with interruption of the tachycardia. A temporary external pacemaker was implanted via a jugular route. The tachycardia recurred after 48 h at a slower rate, and the patient underwent redo ablation. Transoesophageal echocardiography revealed a pseudoaneurysm of the right sinus of Valsalva probably corresponding to an evacuated abscess. A permanent pacemaker was implanted after active infection had been ruled out. At 3 months of follow-up, the patient had complete AVB, without arrhythmia recurrence. Discussion  This is the first case report of JET complicating a paravalvular abscess of the aortic valve with concomitant AVB. Junctional ectopic tachycardia is very rare arrhythmia which is usually seen in children as a congenital arrhythmia or following surgical correction of paediatric heart disease. The differential diagnosis is discussed in detail in the article.

scholarly journals P1247 Bilateral endogenous endophthalmitis as the initial presentation of hacek prosthetic valve infective endocarditis

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
E Parr ◽  
C Mcaloon ◽  
A Morley-Davis ◽  
P Ridley ◽  
S Duckett
Keyword(s):  
Infective Endocarditis ◽  
Prosthetic Valve ◽  
Prosthetic Valve Endocarditis ◽  
Transoesophageal Echocardiography ◽  
Endogenous Endophthalmitis ◽  
Reactive Protein ◽  
First Case ◽  
Black Spots ◽  
Aortic Root Abscess ◽  
History Of

Abstract Summary A 75 year old lady with a prosthetic aortic valve (St Jude mechanical AVR) presented to ophthalmology with a one month history of black spots in the vision of her left eye with a further episode in her right eye two weeks later, leading to a diagnosis of bilateral endogenous endopthalmitis and was admitted to hospital. There was no history of trauma and the chest and abdominal examination was normal. The erythrocyte sedimentation rate (40) and C reactive protein (45.8) were elevated. She had several sets of blood cultures, which were positive for Aggregatibacter actinomycetemcomitans, a HACEK organism and was started on empirical Ceftriaxone. The transthoracic echocardiography was normal. However, the suspicion of Infective Endocarditis (IE) was high, therefore a transoesophageal echocardiography was performed and showed an aortic root abscess (Image 1). An urgent computerised aortogram was performed. Following a planned two week period of intravenous antibiotics the patient was taken to theatre to have a redo AV valve replacement and root repair. Following a prolonged period on intensive care and a six week course of pathogen directed antibiotic therapy she was then fit enough to be discharged. Conclusion We present the first case in the literature of a HACEK Prosthetic Valve endocarditis presenting with bilateral endogenous endophthalmitis. Abstract P1247 Figure. TOE image of Absess

Left coronary cusp ablation to eliminate epicardial substrates – a novel strategy for left ventricular summit ventricular tachycardia ablation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
W Phanthawimol ◽  
Y Komatsu ◽  
M Hattori ◽  
Q.J Naeemah ◽  
S Shimoo ◽  
...  
Keyword(s):  
Coronary Vessels ◽  
Left Ventricular ◽  
Bipolar Electrode ◽  
Coronary Vein ◽  
Ventricular Tachycardia Ablation ◽  
First Case ◽  
Rf Energy ◽  
Coronary Cusp ◽  
Novel Strategy ◽  
Communicating Vein

Abstract Background Catheter ablation of LV summit VT can be challenging due to possible subepicardial or intramural site of origin and its close proximity to the major coronary vessels. Objective Local electrograms monitoring inside LV summit communicating vein potentially defines arrhythmogenic substrates and facilitates ablation from the adjacent anatomical structures. Results We experienced two cases of LV summit VT with epicardial local abnormal ventricular activities (Epi-LAVA) recorded from distal bipolar electrode of the 2F microcatheter in communicating vein close to the superior portion of LV summit. During sinus rhythm, Epi-LAVA displayed isolated late fractionated potentials in the first case but had initial fractionated potentials fused with terminal portion of far-field ventricular signals and late isolated potentials exhibiting 2:1 conduction in the second case. Epi-LAVA represented earliest ventricular signals during VT in both cases. Pace mapping at Epi-LAVA sites yielded single QRS morphology with excellent pacemap score and induced VT. Our strategy was to perform ablation at the facing site of Epi-LAVA aiming to eliminate the potentials transmurally. Radiofrequency (RF) energy was applied above and under the left coronary cusp opposite to Epi-LAVA sites using 3.5-mm tip open-irrigation catheter with a power of 30–35 W for 60 seconds under real-time intracardiac echocardiograhic guidance. VT was slowed and terminated in 1 second. Repeat ablation delayed and completely abolished Epi-LAVA followed by noninducibility of VT. Anatomical proximity of the left coronary cusp semilunar insertion and subepicardial or intramural site of origin possibly dictates successful ablation. Epi-LAVA from coronary vein mapping serve as a new landmark of the ablation target with a measurable procedural endpoint. Conclusion Elimination of epicardial substrates with RF energy application at the left coronary cusp can be a novel strategy for LV summit VT ablation. Funding Acknowledgement Type of funding source: None

scholarly journals Infective Aortic Valve Endocarditis Causing Embolic Consecutive ST-Elevation Myocardial Infarctions

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Kanksha Peddi ◽  
Alexander L. Hsu ◽  
Tomas H. Ayala
Keyword(s):  
Myocardial Infarction ◽  
Infective Endocarditis ◽  
Aortic Valve ◽  
Index Case ◽  
Current Treatment ◽  
Myocardial Infarctions ◽  
Treatment Modalities ◽  
The Past ◽  
First Case ◽  
St Elevation

ST-elevation myocardial infarction (STEMI) is a rare and potentially fatal complication of infective endocarditis. We report the ninth case of embolic native aortic valve infective endocarditis causing STEMI and the first case to describe consecutive embolisms leading to infarctions of separate coronary territories. Through examination of this case in the context of the previous eight similar documented cases in the past, we find that infective endocarditis of the aortic valve can and frequently affect more than a single myocardial territory and can occur consecutively. Further, current treatment modalities for embolic infective endocarditis causing acute myocardial infarction are limited and unproven. This index case illustrates the potential severity of complications and the challenges in developing standardized management for such patients.

scholarly journals Comparing the diagnostic accuracy of computed tomography vs transoesophageal echocardiography for infective endocarditis − A meta-analysis

2022 ◽  
Vol 38 (3) ◽  
Author(s):  
Liqin Jing ◽  
Yanchun Song
Keyword(s):  
Computed Tomography ◽  
Infective Endocarditis ◽  
Diagnostic Accuracy ◽  
English Language ◽  
Cardiac Computed Tomography ◽  
Meta Analysis ◽  
Transoesophageal Echocardiography ◽  
Cochrane Central Register ◽  
Index Test ◽  
Creative Commons

Objective: To investigate the comparative diagnostic accuracy of cardiac computed tomography (CT) and transoesophageal echocardiography (TEE) for detecting infective endocarditis. Methods: Original publications published in English language before July, 2021 were thoroughly search in PubMed, CENTRAL (Cochrane Central Register of Controlled Trials), and Google Scholar literature databases. Studies were included if they used CT and/or TEE as an index test, presented data on valvular complications related to infective endocarditis, and used surgical findings as to the reference standard. Results:­­­ Literature screening identified fifteen studies that fulfilled the inclusion criteria. Meta-analysis showed that CT sensitivity for detecting valvular abscesses was higher than that of TEE [0.88 (95% confidence interval [CI]: 0.82 to 0.94; 11 studies involving 842 subjects) versus 0.74 (95% CI: 0.65 to 0.84) P = 0.015; 12 studies involving 917 subjects]. TEE showed statistically significantly greater sensitivity than CT for detecting valvular vegetation [0.91 (95% CI: 0.84 to 0.97, 11 studies involving 971 subjects) versus 0.80 (95% CI: 0.69 to 0.82), 12 studies involving 915 subjects, P =0.019. In case of leaflet detection, TEE showed statistically significantly higher sensitivity than CT (0.76 vs 0.46, P =0.010). Conclusion: CT performs statistically significantly better than TEE for detecting abscesses while TEE provides statistically significant superior results for detecting vegetation. There is a need for well-designed prospective studies to further corroborate these findings. doi: https://doi.org/10.12669/pjms.38.3.5139 How to cite this:Jing L, Song Y. Comparing the diagnostic accuracy of computed tomography vs transoesophageal echocardiography for infective endocarditis − A meta-analysis . Pak J Med Sci. 2022;38(3):---------. doi: https://doi.org/10.12669/pjms.38.3.5139 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals CHANGES IN THE MUCOSA OF THE UTERINE POD IN CANCER OF THE VAGINAL PART AND CERVIX

2020 ◽  
Vol 5 (5) ◽  
pp. 410-435
Author(s):  
M. Mironov
Keyword(s):  
Mucous Membrane ◽  
Individual Case ◽  
The Body ◽  
Lymphoid Cells ◽  
Surface Layers ◽  
First Case ◽  
Epitheloid Cells ◽  
Deep Layers ◽  
High Degree ◽  
Sarcomatous Degeneration

Changes in the mucous membrane of the body of the uterus, accompanying cancer of the vaginal part and cervix, drew special attention after the work of Abel (see No. I), which appeared in 1888. The author studied the mucous membrane of the body of the uterus, taken from extirpated cases of 6 uterus for carcinoma portionis and in 1 case for carcinoma cervicis. "In all cases, the mucous membrane is dull," says the author (p. 279, 1. p.), To a high degree of alteration, while the mucous membrane of the cervix is ​​relatively insignificantly diseased. " These changes, as can be seen from the description of each individual case, concern both the gland and the intermediate tissue, and the first in all cases were multiplied and represented corkscrew gyrus; some of them were enlarged or contained ectases of the lateral walls and processes protruding into the lumen of the gland. Changes in the intermediate tissue in cases 1, 2 and 4 consisted in the multiplication of cells in deep layers, and here they had a short-spindle-shaped shape, small size and went in trains in different directions; in the surface layers, they were more or less round, much larger in size and resembled epitheloid cells. In addition, a nested infiltration with small, round cells (lymphoid cells?) Met in places. In the remaining 4 cases, the changes in the intermediate tissue, according to the author's description, were the same as usually in chronic inflammation (cases 5, 6 and 7) or almost absent (case 3). On the basis of these studies, the author comes to the conclusion that changes in the mucous membrane of the body of the uterus in cancer of the vaginal part and cervix have the character of sarcomatous degeneration, which in observed 1, 2 and 4-m, already reached a rather high degree of 4, in the rest, although it did not appear as sharp as especially in the first case, but nevertheless, these changes, according to the author, cannot be considered as inflammatory, but should be taken only as a more weak degree of the same sarcomatous degeneration, by analogy with the first.

Polymerase chain reaction in the diagnosis of parotid gland tuberculosis

1998 ◽  
Vol 112 (5) ◽  
pp. 494-496 ◽  
Author(s):  
Enis Alpin Güneri ◽  
Ahmet Ömer İkiz ◽  
Nese Atabey ◽  
Özlem İzci ◽  
Semih Sütay
Keyword(s):  
Polymerase Chain Reaction ◽  
Differential Diagnosis ◽  
Parotid Gland ◽  
Mycobacterial Infection ◽  
Social Characteristics ◽  
Causative Organism ◽  
Chain Reaction ◽  
First Case ◽  
Polymerase Chain ◽  
High Degree

AbstractA parotid gland mass with presenting features of malignancy is a diagnostic and therapeutic challenge. The histological nature of the lesion must be clearly determined before proceeding with facial nerve sacrificing surgery. Although rare, tuberculosis of the parotid gland must be included in the differential diagnosis of a parotid gland mass especially when the social characteristics of the patient suggests a mycobacterial infection. Primary tuberculosis of the parotid gland is generally encountered among populations with a high incidence of pulmonary disease. The difficulty in the differential diagnosis of a parotid gland malignancy may be helped by a high degree of clinical suspicion, since laboratory tests generally do not identify the specific causative organism. This article reports the first case of parotid gland tuberculosis with clinical and radiodiagnostical features simulating malignancy in which the diagnosis was confirmed by the polymerase chain reaction (PCR).

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