Intracranial mycotic aneurysm is associated with cerebral bleeding post-valve surgery for infective endocarditis†

<p class="p1"><span class="s1">Mycotic aneurysm of the superior mesenteric artery (SMA) is a rare complication of infective endocarditis. We report a case with infective endocarditis involving the aortic valve complicated by multiple septic embolisms. The patient was treated with antibiotics for 6 weeks. During preparation for surgical treatment, the patient developed acute abdominal pain and was diagnosed with a ruptured SMA aneurysm, which was successfully treated with an emergency operation of aneurysm ligation. The aortic valve was replaced 17 days later and the patient recovered uneventfully. In conclusion, we present a rare case with infective endocarditis (IE) complicated by SMA aneurysm. Antibiotic treatment did not prevent the rupture of SMA aneurysm. Abdominal pain in a patient with a recent history of IE should be excluded with ruptured aneurysm.</span></p>

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Faculty Opinions recommendation of Impact of early valve surgery on outcome of Staphylococcus aureus prosthetic valve infective endocarditis: analysis in the International Collaboration of Endocarditis-Prospective Cohort Study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.725233167.793510603 ◽

2015 ◽

Author(s):

Bernard Prendergast

Keyword(s):

Staphylococcus Aureus ◽

Cohort Study ◽

Infective Endocarditis ◽

Prospective Cohort Study ◽

International Collaboration ◽

Prospective Cohort ◽

Prosthetic Valve ◽

Valve Surgery

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Age differences in mortality in patients undergoing surgery for infective endocarditis

European Heart Journal ◽

10.1093/ehjci/ehaa946.2021 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

L Ostergaard ◽

M.H Smerup ◽

K Iversen ◽

A.D Jensen ◽

A Dahl ◽

...

Keyword(s):

Infective Endocarditis ◽

Aortic Valve ◽

Hospital Mortality ◽

Hazard Analysis ◽

Age Groups ◽

Prosthetic Heart Valve ◽

Valve Surgery ◽

Aortic Valve Surgery ◽

Factors Associated ◽

Increased Risk

Abstract Background Infective endocarditis (IE) is associated with high mortality. Surgery may improve survival, but the intercept between benefit and harm is hard to balance and may be closely related to age. Purpose To examine the in-hospital and 90-day mortality in patients undergoing surgery for IE and to identify differences between age groups and type of valvular intervention. Methods By crosslinking nationwide Danish registries we identified patients with first-time IE undergoing surgical treatment in the period from 2000 to 2017. The study population was grouped in patients <60 years, 60–75 years, and ≥75 years of age. High-risk subgroups by age and surgical valve intervention (mitral vs aortic vs mitral+aortic) during IE admission were examined. Kaplan Meier estimates was used to identify 90-day mortality by age groups and multivariable adjusted Cox proportional hazard analysis was used to examine factors associated with 90-day mortality. Results We included 1,767 patients with IE undergoing surgery, 735 patients <60 years (24.1% female), 766 patients 60–75 years (25.8% female), and 266 patients >75 years (36.1% female). The proportion of patients with IE undergoing surgery was 35.3%, 26.9%, and 9.1% for patients <60 years, 60–75 years, and >75 years, respectively. For patients with IE undergoing surgery, the in-hospital mortality was 6.4%, 13.6%, and 20.3% for patients <60 years, 60–75 years, and ≥75 years of age, respectively and mortality at 90 days were 7.5%, 13.9%, and 22.3%, respectively. Factors associated with an increased risk 90-day mortality were: mitral valve surgery and a combination of mitral and aortic valve surgery as compared with isolated aortic valve surgery, patients 60–75 years and >75 years as compared with patients aged <60 years, prosthetic heart valve prior to IE admission, and diabetes, Figure. Patients >75 years undergoing a combination of mitral and aortic valve surgery had an in-hospital mortality of 36.3%. Conclusion In patients undergoing surgery for IE, a stepwise increase in 90-day mortality was seen for age groups, highest among patients >75 years with a 90-day mortality of more than 20%. Patients undergoing mitral and combined mitral and aortic valve surgery as compared to isolated aortic valve surgery were associated with a higher mortality. These findings may be of importance for the management strategy of patients with IE. Mortality risk Funding Acknowledgement Type of funding source: None

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Unusual Intracranial Manifestation of Infective Endocarditis

The Open Neuroimaging Journal ◽

10.2174/1874440002114010028 ◽

2021 ◽

Vol 14 (1) ◽

pp. 28-32

Author(s):

Keerthiraj Bele ◽

Sonali Ullal ◽

Ajit Mahale ◽

Sriti Rani

Keyword(s):

Infective Endocarditis ◽

Early Diagnosis ◽

Cerebral Artery ◽

Mycotic Aneurysm ◽

Parent Artery ◽

Left Middle Cerebral Artery ◽

Risk Of Rupture ◽

Complete Obliteration ◽

Glue Embolization ◽

Left Middle

Objective: The mycotic aneurysm is a rare intracranial pathology seen with pre-existing infective endocarditis. It has a high mortality rate due to its risk of rupture and needs early diagnosis and treatment. Methods: A 23-year male patient who presented with infective endocarditis subsequently developed a left parietal-temporal intracranial haemorrhage with suspicion of aneurysm after the course of antibiotic treatment as seen on Computed Tomography (CT) scan. Digital Subtraction Angiography (DSA) revealed a ruptured fusosaccular aneurysm in the distal parietal branches of the left Middle Cerebral Artery (MCA), for which glue embolization of the distal parent artery and aneurysm was done. Result: The interventional endovascular procedure was done with complete obliteration of the distal parent artery, mycotic aneurysm, and normal filling of the left internal cerebral artery (ICA) branches. Conclusion: Mycotic intracranial aneurysms (MIA) are a rare form of cerebrovascular pathology which needs early diagnosis with endovascular intervention when rupture occurs.

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Ruptured distal middle cerebral artery mycotic aneurysm: A rare, first presentation of infective endocarditis

Asian Journal of Neurosurgery ◽

10.4103/1793-5482.180927 ◽

2018 ◽

Vol 13 (1) ◽

pp. 113

Author(s):

Sumit Sinha ◽

DipankerSingh Mankotia ◽

BhawaniShankar Sharma

Keyword(s):

Infective Endocarditis ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Mycotic Aneurysm ◽

Distal Middle Cerebral Artery

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155. Infective Endocarditis and Cardiac Valve Surgery During the Opioid Epidemic in North Carolina, 2007 to 2017

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy209.025 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S12-S12

Author(s):

Asher Schranz ◽

Aaron Fleischauer ◽

Vivian H Chu ◽

David Rosen

Keyword(s):

North Carolina ◽

Infective Endocarditis ◽

Drug Use ◽

Fold Increase ◽

International Classification Of Diseases ◽

Valve Surgery ◽

Cardiac Valve ◽

Hospital Charges ◽

Opioid Epidemic ◽

Cardiac Valve Surgery

Abstract Background Infective endocarditis (IE) associated with drug use (DA-IE) is rising nationally. North Carolina (NC), a state hard-hit by the opioid epidemic, saw an over 12-fold increase in DA-IE from 2010 to 2015. Concerns about surgery exist due to the risk of ongoing drug use and reinfection after valvuloplasty. We evaluated trends, characteristics, and outcomes of valve surgery for DA-IE, compared with IE not associated with drug use (non-DA-IE), in NC. Methods We analyzed the NC Discharge Database, which includes administrative data from all hospital discharges in NC. Using International Classification of Diseases codes, we identified all persons ≥18 years of age with IE from July 1, 2007 to June 30, 2017. Hospitalizations were deemed DA-IE by a diagnosis code related to illicit drug use, dependence, poisoning or withdrawal (excepting marijuana), or Hepatitis C in a person born after 1965. All others were labeled non-DA-IE. Procedure codes were queried to identify cardiac valve surgery. Year-to-year trends in surgery for IE by drug-associated status were reported. Demographics, length of stay (LOS), charges, and disposition were compared among DA-IE and non-DA-IE. Results A total of 22,809 hospitalizations were coded for IE. Valve surgery occurred in 1,652. Of surgical hospitalizations, 17% overall and 42% in the final study year were DA-IE. Hospitalizations for DA-IE where surgery was done increased from <10 through 2012–2013 to 109 in 2016–2017 (figure). Compared with non-DA-IE, those undergoing surgery for DA-IE were younger (median age 33 vs. 56), female (47% vs. 33%), White (89% vs. 64%), uninsured (34% vs. 11%), insured by Medicaid (39% vs. 13%), and had tricuspid valve surgery (38% vs. 11%). DA-IE had longer median LOS (27 vs. 17 days) and were less often discharged home (51% vs. 59%). For the 287 DA-IE admissions with surgery, median hospital charges were $247,524, totaling over $79,000,000. All comparisons were significant at P < 0.0001. Conclusion From 2007 to 2017, valve surgeries for DA-IE in NC rose over tenfold and are approaching half of all surgeries for IE. This phenomenon is an underappreciated and morbid component of the opioid epidemic that burdens hospital and state resources. Research into best practices for managing patients with DA-IE and addressing addiction in this setting is critically needed. Disclosures All authors: No reported disclosures.

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Surgery-first treatment improves clinical results in infective endocarditis complicated with disseminated intravascular coagulation†

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz068 ◽

2019 ◽

Vol 56 (4) ◽

pp. 785-792 ◽

Cited By ~ 1

Author(s):

Junya Yokoyama ◽

Daisuke Yoshioka ◽

Koichi Toda ◽

Ryohei Matsuura ◽

Kota Suzuki ◽

...

Keyword(s):

Overall Survival ◽

Infective Endocarditis ◽

Medical Treatment ◽

Disseminated Intravascular Coagulation ◽

Treatment Strategy ◽

Survival Rates ◽

Valve Surgery ◽

Intravascular Coagulation ◽

Surgery First ◽

Overall Survival Rates

Abstract OBJECTIVES: Infective endocarditis (IE) is a critical infection with a high mortality rate, and it usually causes sepsis. Though disseminated intravascular coagulation (DIC) sometimes occurs in IE patients, no definitive treatment strategy for IE patients with DIC as a complication exists. Therefore, we evaluated the prevalence, surgical results and treatment strategy for IE complicated with DIC. METHODS: Between 2009 and 2017, a total of 585 patients undergoing valve surgery for active IE were enrolled at 14 institutions, of whom 116 (20%) had DIC as a complication. For further evaluation, we divided DIC patients into medical treatment-first (n = 45, group M) and valve surgery-first (n = 51, group S) groups after excluding 20 patients with intracranial haemorrhage. RESULTS: The overall survival rates at 1 and 5 years were 91% and 85% in the non-DIC group and 65% and 55% in the DIC group, respectively (P < 0.001). Recurrence-free survival rates at 1 and 5 years were 99% and 95% in the non-DIC group and 94% and 74% in the DIC group, respectively (P < 0.001). The overall survival rates at 1 and 5 years were 77% and 64% in group S and 51% and 46% in group M, respectively (P = 0.032). Multivariable analysis revealed that ‘medical treatment first’ was an exclusive independent risk factor [hazards ratio 2.26 (1.13–4.75), P = 0.024] for overall mortality. CONCLUSIONS: Mortality and IE recurrence were statistically significantly higher in DIC patients. Valve surgery should not be delayed because most patients proceeding with medical treatment eventually require emergency surgery and their clinical outcomes are worse than those of patients undergoing early surgery.

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Drug Use and Postoperative Mortality Following Valve Surgery for Infective Endocarditis: A Systematic Review and Meta-analysis

Clinical Infectious Diseases ◽

10.1093/cid/ciy1064 ◽

2018 ◽

Vol 69 (7) ◽

pp. 1120-1129 ◽

Cited By ~ 15

Author(s):

Ryan Hall ◽

Michael Shaughnessy ◽

Griffin Boll ◽

Kenneth Warner ◽

Helen W Boucher ◽

...

Keyword(s):

Systematic Review ◽

Infective Endocarditis ◽

Drug Use ◽

Injection Drug Use ◽

Systematic Reviews ◽

Meta Analysis ◽

Postoperative Mortality ◽

Valve Surgery ◽

Injection Drug ◽

Significant Difference

AbstractBackgroundInfective endocarditis (IE) often requires surgical intervention. An increasingly common cause of IE is injection drug use (IDU-IE). There is conflicting evidence on whether postoperative mortality differs between people with IDU-IE and people with IE from etiologies other than injection drug use (non–IDU-IE). In this manuscript, we compare short-term postoperative mortality in IDU-IE vs non–IDU-IE through systematic review and meta-analysis.MethodsThe review was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Publication databases were queried for key terms included in articles up to September 2017. Randomized controlled trials, prospective cohorts, or retrospective cohorts that reported on 30-day mortality or in-hospital/operative mortality following valve surgery and that compared outcomes between IDU-IE and non–IDU-IE were included.ResultsThirteen studies with 1593 patients (n = 341 [21.4%] IDU-IE) were included in the meta-analysis. IDU-IE patients more frequently had tricuspid valve infection, Staphylococcus infection, and heart failure before surgery. Meta-analysis revealed no statistically significant difference in 30-day postsurgical mortality or in-hospital mortality between the 2 groups.ConclusionsDespite differing preoperative clinical characteristics, early postoperative mortality does not differ between IDU-IE and non–IDU-IE patients who undergo valve surgery. Future research on long-term outcomes following valve replacement is needed to identify opportunities for improved healthcare delivery with IDU-IE.

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