scholarly journals A tale of four valves: outcome of Brucella endocarditis: a case series

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Suraj Kumar Kulkarni ◽  
Shivakumar Bhairappa ◽  
Kapil Rangan ◽  
Beeresh P
Keyword(s):  
New York ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Case Series ◽  
Heart Association ◽  
Limb Ischaemia ◽  
Intermittent Fever ◽  
Peripheral Embolization ◽  
Acute Limb Ischaemia

Abstract Background Brucellosis is a zoonotic infection. Humans contract brucellosis through inhalation of aerosolized infected particles, or when they come in direct contact with infected animal parts, or on consuming unpasteurised dairy products. It can affect multiple organs and systems. Endocarditis is diagnosed late in the course of the disease with mostly aortic valve involvement with serious morbidity and mortality. Case summary We report a case series of four patients with Brucella endocarditis. The first patient presented with fever, malaise, and exertional breathlessness. He underwent aortic valve replacement for refractory heart failure and bulky vegetations after failed medical therapy. The second patient presented with fever, breathlessness New York Heart Association (NYHA) III, with arthralgia, myalgia, anorexia, and weight loss. In view of aortic abscess with impending rupture and compression of left main coronary artery, aortic valve replacement was performed on the 4th day of antibiotic treatment. The third patient presented with fever, fatigue, NYHA II, and developed peripheral embolization but responded to medical treatment alone. The fourth patient presented with intermittent fever for 7 months. During hospitalization, he suffered acute limb ischaemia and stroke with absence of left dorsalis pedis and posterior tibial pulsation. Brucella IgG ELISA was positive. Mitral valve replacement was done subsequently with unremarkable hospital course. Discussion Brucellosis is a challenging diagnosis to make. The diagnosis and treatment is often delayed as it presents with non-specific symptoms and signs. Cardiac involvement occurs in only 2% of the cases, but accounts for 80% of the mortality due to brucellosis. Brucella endocarditis should be suspected in cases of endocarditis with negative blood cultures and a risk of exposure. The most accepted treatment for Brucella endocarditis is a combination of antimicrobial therapy with surgery.

An Early Canadian Experience with the Correx Automated Coring and Apical Connector Device for Aortic Valve Bypass

2016 ◽  
Vol 11 (6) ◽  
pp. 434-438
Author(s):  
Hussein A. Al-Amodi ◽  
Christopher L. Tarola ◽  
Hamad F. Alhabib ◽  
Corey Adams ◽  
Linrui Ray Guo ◽  
...  
Keyword(s):  
New York ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Heart Association ◽  
Left Ventricular ◽  
Functional Class ◽  
New York Heart Association ◽  
Apical Connector ◽  
Aortic Valve Bypass

Objective Aortic valve replacement is the standard of care for severe, symptomatic aortic valve stenosis (AS); however, anatomy or preexisting comorbidities may preclude conventional or alternative transcatheter approaches. Aortic valve bypass (AVB) may be performed as a salvage procedure for the relief of symptomatic aortic stenosis in patients who are not suitable candidates for aortic valve replacement. Methods At our institution, seven patients underwent AVB using the Correx automated coring and apical connector system. All patients had severe AS with New York Heart Association functional class 3 symptoms and were not candidates for conventional or transcatheter approaches. Via a left anterolateral thoracotomy to access the descending aorta and left ventricular apex, we used the Correx system (Correx, Waltham, MA USA) to anastomose a valve conduit to the left ventricular apex proximally and the descending aorta distally. Three patients required cardiopulmonary bypass. Results In all seven patients, the automated coring and apical connector was successfully deployed. There were two in-hospital deaths in this series. Immediately postoperatively and at 3 months, there was a significant reduction in mean and peak valve gradients, and all surviving patients performed at New York Heart Association functional class 1. Conclusions Aortic valve bypass seems to be an acceptable alternative for the treatment of severe AS in high-risk patients who are not candidates for aortic valve replacement. The Correx automated system may improve the clinical applicability and surgical repro-ducibility of AVB in appropriately selected patients in which conventional or transcatheter aortic valve replacement is not a feasible options.

scholarly journals Transcatheter aortic valve replacement same-day discharge for selected patients: a case series

2021 ◽  
Vol 5 (2) ◽  
Author(s):  
Devesh Rai ◽  
Muhammad Waqas Tahir ◽  
Medhat Chowdhury ◽  
Hammad Ali ◽  
Rupinder Buttar ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Real Time ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Case Series ◽  
Cardiac Monitoring ◽  
Atrial Pacing ◽  
Transcatheter Aortic Valve ◽  
Same Day Discharge

Abstract Background The coronavirus disease 2019 (COVID-19) pandemic has resulted in drastic changes to the practice of medicine, requiring healthcare systems to find solutions to reduce the risk of infection. Using a case series, we propose a protocol for same-day discharge (SDD) for selected patients undergoing transcatheter aortic valve replacement (TAVR) using real-time remote cardiac monitoring. Six patients with severe symptomatic aortic stenosis underwent TAVR and were discharged on the same day. Case summary Six patients with symptomatic severe native or bioprosthetic aortic valve stenosis underwent a successful transfemoral TAVR using standard procedures, including the use of rapid atrial pacing to assess the need for permanent pacemaker implantation. Following TAVR, patients were monitored on telemetry in the recovery area for 3 h, ambulated to assess vascular access stability, and discharged with real-time remote cardiac monitoring if no new conduction abnormality was observed. The patients were seen by tele-visits within 2 days and 2 weeks after discharge. Discussion Amidst the COVID-19 pandemic, SDD following successful transfemoral TAVR may be feasible for selected patients and reduce potential COVID-19 exposure.

Application of transcatheter valves for aortic valve replacement in pediatric patients: A case series

2019 ◽  
Vol 95 (2) ◽  
pp. 253-261 ◽  
Author(s):  
Sanjay Sinha ◽  
Asra Khan ◽  
Athar M. Qureshi ◽  
William Suh ◽  
Hillel Laks ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Pediatric Patients ◽  
Case Series ◽  
Transcatheter Valves

Successfully minimal approach ViV-TAVR without angiography in a severe restenosis with renal dysfunction 17 years post-surgical aortic valve replacement: A case report

Perfusion ◽  
2020 ◽  
pp. 026765912097352
Author(s):  
Xiaofei Jiang ◽  
Zhe Zhang ◽  
Kun Wang ◽  
Jie Li
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Renal Dysfunction ◽  
Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Kidney Injury ◽  
Heart Association ◽  
Functional Class ◽  
Class Iii ◽  
Surgical Aortic Valve Replacement

Severe aortic stenosis (AS) is a major cause of morbidity and mortality in the elderly. Transcatheter aortic valve replacement (TAVR) is an approach in cardiovascular interventional therapy. As we known, most of the candidates for TAVR are suffered from advanced heart dysfunction (New York Heart Association functional class III or IV) and chronic kidney disease. However, contrast-enhanced computed tomography and coronary angiography are necessary for pre-procedures for TAVR. TAVR could have adverse effects on kidney function including contrast-induced acute kidney injury (CI-AKI), which is related to poor prognosis. In a severe recurrent valve stenosis with progressive renal dysfunction, receiving surgical aortic valve replacement (SAVR) using bioprosthetic valve (BV) 17 years ago, we successfully reversed restenosis by performing pre-procedure evaluating and valve-in-valve (ViV) TAVR without angiography. Angiography-free TAVR may be a beneficial approach for patients with aortic restenosis after SAVR complicated with renal dysfunction.

Abstract 13908: Prevalence and Implications of Junctional Rhythm During Transcatheter Aortic Valve Replacement

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Natthapon Angsubhakorn ◽  
Maria Anderson ◽  
Baris Akdemir ◽  
Stefan C Bertog ◽  
Santiago Garcia ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Case Series ◽  
Cardiac Conduction ◽  
Ventricular Rate ◽  
P Waves ◽  
Junctional Rhythm ◽  
Transcatheter Aortic Valve

Introduction: Cardiac conduction abnormalities are among the most frequent complications of transcatheter aortic valve replacement (TAVR). A small case series has raised the possibility that junctional rhythm (JR) following TAVR may be associated with poor outcomes. However, the prevalence and implications of JR during TAVR have not been systematically studied. Methods: We retrospectively reviewed intra-procedural continuous 6-lead telemetry of 300 consecutive patients undergoing TAVR between April 2015 and April 2019 to identify JR that occurred after deploying the valve . Forty-two patients with pre-existing permanent pacemaker (PPM) were excluded. JR was defined as regular rhythm without P waves but with QRS morphology that was identical to baseline. Results: A total of 258 patients fulfilled the inclusion criteria (mean age of 77.5±8.5 years and 99% men). During TAVR, 79 (30.6%) patients developed new JR. The mean ventricular rate was 74.6±31.0 bpm. Patients who developed JR had similar baseline characteristics compared to those without JR (Table). After TAVR, 57 (22.1%) patients required PPM for complete atrioventricular block. There was a trend for a higher rate of PPM implantation in patients with rapid JR (39%) vs. slow JR (26%) vs. no JR (19.0%, p=0.10). In logistic regression analysis, patients who had a rapid JR (rate >100 bpm) were 2.71 times (95% CI 0.98-7.52, p=0.055) more likely to require PPM than those without JR. Conclusions: Junctional rhythm after deploying the valve is common in TAVR. There was a trend for higher PPM implantation risk among patients who developed rapid JR. Further investigation of these observations in larger cohorts is needed.

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