scholarly journals 1074. Management and Outcomes of Infective Endocarditis Due to Nutritionally Variant Streptococci

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S321-S322
Author(s):  
Madiha Fida ◽  
Tarab Mansoor ◽  
Omar Abu Saleh ◽  
Ahmed Hamdi ◽  
Daniel C Desimone ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Infective Endocarditis ◽  
Mitral Valve ◽  
Mitral Valve Prolapse ◽  
Case Series ◽  
High Rate ◽  
In Vitro Susceptibility ◽  
Duke Criteria ◽  
Significant Difference

Abstract Background Nutritionally variant streptococci (NVS) are an infrequent cause of infective endocarditis (IE) and management recommendations are based on weak levels of evidence largely derived from case reports, small case series, and animal models of experimental endocarditis. Moreover, taxonomic changes have led to some confusion in designation of these organisms. Methods We retrospectively collected and analyzed data from 33 patients with NVS IE from 1970 to 2017. Only patients who met modified Duke Criteria for IE were included. Results Mean patient age was 55 years and 61% were males. The most common comorbidities included diabetes mellitus (12%), malignancy (3%), heart failure (16%), coronary artery disease (25%), and chronic liver disease (9%). Predisposing valve abnormalities included rheumatic heart disease (11%), bicuspid aortic valve (22%), transplant valvulopathy (3%), mitral valve prolapse (3%), and congenital heart disease (11%). Cultures were reported as NVS (70%), Granulicatella species (18%) and Abiotrophia species (12%). Echocardiogram findings included vegetations (67%), new regurgitation (55%), perivalvular abscess (3%), mitral valve prolapse (3%), and ruptured mitral valve chordae (3%). Both prosthetic (26%) and native valve IE (74%) was seen, and the valves involved were aortic (37%), mitral (50%) and both aortic and mitral (13%). Complications were seen in 27% of patients, including heart failure (17%), splenic infarct (11%), stroke (8%), mycotic aneurysm (3%), and glomerulonephritis (2%). In vitro susceptibility to penicillin, ceftriaxone, and vancomycin was 88%, 80%, and 100%, respectively. The majority (77%) of patients were treated with a combination of β-lactam and aminoglycoside. Median duration of treatment was 33 days. Surgery was performed in 50% of patients with no significant difference in survival between those who were treated with combined medical/surgical treatment and those treated with medical therapy alone. Overall survival at 1, 4, and 10 years was 93%, 83%, and 66%, respectively. Conclusion IE due to NVS is a rare entity and is associated with a high rate of serious complications and may involve multiple valves. Long-term, two-thirds of the patients survived more than 10 years. Disclosures All authors: No reported disclosures.

scholarly journals Streptococcus pyogenes Infective Endocarditis – Association with Injection Drug Use: Case Series and Review of the Literature

2021 ◽  
Author(s):  
Melanie T Rebechi ◽  
Emily L Heil ◽  
Paul M Luethy ◽  
Sarah A Schmalzle
Keyword(s):  
Infective Endocarditis ◽  
Streptococcus Pyogenes ◽  
People Who Inject Drugs ◽  
Local Population ◽  
Case Series ◽  
Duke Criteria ◽  
Group A ◽  
Polymicrobial Bacteremia ◽  
Predominantly Female ◽  
Living With Hiv

Abstract Background Streptococcus pyogenes, or Group A Strep (GAS), is not considered a typical cause of infective endocarditis (IE), but has anecdotally been observed in unexpectedly high rates in people who inject drugs (PWID) at our institution. Methods All cases of possible or definite GAS IE per Modified Duke Criteria in adults at an academic hospital between 11/15/2015 and 11/15/2020 were identified. Medical records were reviewed for demographics, comorbidities, treatment, and outcomes related to GAS IE. Literature on cases of GAS IE was reviewed. Results 18 cases of probable (11) or definite (7) GAS IE were identified; mean age was 38 years, and the population was predominantly female (56%) and Caucasian (67%), which is inconsistent with local population demographics. Sixteen cases were in people who inject drugs (PWID) (89%), 14 were also homeless, six were also living with HIV (33%), and two were also pregnant. Antibiotic regimens were variable due to polymicrobial bacteremia (39%). One patient underwent surgical valve replacement. Four patients (22%) died due to complications of infection. Literature review revealed 42 adult cases of GAS IE, only 17 of which were in PWID (24%). Conclusions The 16 cases of possible and definite GAS IE in PWID over a five-year period in a single institution reported nearly doubles the number of cases in PWID from all previous reports. This suggests a potential increase in GAS IE particularly in PWID and PLWH, which warrants further epidemiologic investigation.

Early Surgical Intervention for Infective Endocarditis

2002 ◽  
Vol 10 (4) ◽  
pp. 298-301 ◽  
Author(s):  
Hong Sheng Zhu ◽  
Pei Yan Yao ◽  
Jia Hao Zheng ◽  
A Thomas Pezzella
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Heart Disease ◽  
Infective Endocarditis ◽  
Complex Disease ◽  
Surgical Intervention ◽  
Elective Surgery ◽  
Postoperative Bleeding ◽  
Arterial Embolization ◽  
Early Surgical Intervention

Infective endocarditis remains a serious and complex disease with significant morbidity and mortality. Sixty cases of infective endocarditis were retrospectively reviewed, consisting of 41 males and 19 females aged 7 to 50 years (mean, 30 years). Congenital heart disease was diagnosed in 19 of the patients and rheumatic heart disease in 41. Congestive heart failure occurred in 36 and systemic embolism in 8 cases. Blood cultures were positive in only 21.7% of the cases, while vegetations were detected by 2-dimensional echocardiography in 70%. Elective surgery was performed in 57 patients and emergent operation for systemic arterial embolization and/or intractable congestive heart failure in 3 patients. Two patients required reoperation for postoperative bleeding. All but 2 patients had been followed up for 6 to 160 months with no evidence of reinfection. Three patients with mechanical valve implantation later died of intracranial bleeding due to over-anticoagulation. The remaining 55 resumed normal activity. The encouraging outcomes were the result of an aggressive diagnostic approach and early surgical intervention.

Valvular Heart Disease - Part II

2021 ◽  
Author(s):  
Miriam S. Jacob ◽  
Brian P Griffin
Keyword(s):  
Heart Disease ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Aortic Stenosis ◽  
Aortic Regurgitation ◽  
Valvular Heart Disease ◽  
Mitral Valve Prolapse ◽  
Developed Countries ◽  
Cardiac Morbidity ◽  
Mechanical Prostheses

Valvular heart disease is an important cause of cardiac morbidity in developed countries despite a decline in the prevalence of rheumatic disease in those countries. This chapter discusses the many etiologies of valvular heart disease and presents methods for assessment and management. Specific valvular lesions discussed include mitral stenosis, mitral regurgitation, mitral valve prolapse, aortic stenosis, aortic regurgitation, and tricuspid and pulmonary disease. The section on tricuspid disease includes a discussion of mechanical prostheses (ball-in-cage and tilting-disk) and biologic prostheses (xenografts, allografts, and autografts) and their complications.  This review contains 5 figures, 9 tables, and 53 references. Keywords: Valvular heart disease, stenosis, regurgitation, mitral regurgitation, mitral valve prolapse (MVP), aortic stenosis, congenital bicuspid valve, senile valvular calcification, aortic regurgitation, chordae or papillary muscles

scholarly journals Replacement Myocardial Fibrosis in Patients with Mitral Valve Prolapse: Relation to Mitral Regurgitation, Ventricular Remodeling and Arrhythmia

Circulation ◽  
2021 ◽  
Author(s):  
Anne-Laure Constant Dit Beaufils ◽  
Olivier Huttin ◽  
Antoine Jobbe-Duval ◽  
Thomas Senage ◽  
Laura Filippetti ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Ventricular Arrhythmia ◽  
Myocardial Fibrosis ◽  
Mitral Valve Prolapse ◽  
Cardiovascular Events ◽  
Prognostic Significance ◽  
Left Ventricular ◽  
Arterial Embolism

Background: Mitral valve prolapse (MVP) is a frequent disease that can be complicated by mitral regurgitation (MR), heart failure, arterial embolism, rhythm disorders and death. Left ventricular (LV) replacement myocardial fibrosis, a marker of maladaptive remodeling, has been described in patients with MVP, but the implications of this finding remain scarcely explored. We aimed at assessing the prevalence, pathophysiological and prognostic significance of LV replacement myocardial fibrosis through late gadolinium enhancement (LGE) by cardiac magnetic resonance (CMR) in patients with MVP. Methods: Four hundred patients (53±15 years, 55% male) with MVP (trace to severe MR by echocardiography) from 2 centers, who underwent a comprehensive echocardiography and LGE CMR, were included. Correlates of replacement myocardial fibrosis (LGE+), influence of MR degree, and ventricular arrhythmia were assessed. The primary outcome was a composite of cardiovascular events (cardiac death, heart failure, new-onset atrial fibrillation, arterial embolism, and life-threatening ventricular arrhythmia). Results: Replacement myocardial fibrosis (LGE+) was observed in 110 patients (28%; 91 myocardial wall including 71 basal inferolateral wall, 29 papillary muscle). LGE+ prevalence was 13% in trace-mild MR, 28% in moderate and 37% in severe MR, and was associated with specific features of mitral valve apparatus, more dilated LV and more frequent ventricular arrhythmias (45 vs 26%, P<0.0001). In trace-mild MR, despite the absence of significant volume overload, abnormal LV dilatation was observed in 16% of patients and ventricular arrhythmia in 25%. Correlates of LGE+ in multivariable analysis were LV mass (OR 1.01, 95% CI [1.002-1.017], P=0.009) and moderate-severe MR (OR: 2.28, 95% CI [1.21-4.31], P=0.011). LGE+ was associated with worse 4-year cardiovascular event-free survival (49.6±11.7 in LGE+ vs 73.3±6.5% in LGE-, P<0.0001). In a stepwise multivariable Cox model, MR volume and LGE+ (HR: 2.6 [1.4-4.9], P=0.002) were associated with poor outcome. Conclusions: LV replacement myocardial fibrosis is frequent in patients with MVP, is associated with mitral valve apparatus alteration, more dilated LV, MR grade, ventricular arrhythmia, and is independently associated with cardiovascular events. These findings suggest a MVP-related myocardial disease. Finally, CMR provides additional information to echocardiography in MVP.

scholarly journals The state of response of autonomic nervous system in children with mitral valve prolapse

2021 ◽  
Vol 26 (4) ◽  
pp. 74-80
Author(s):  
І.О.  Mitiuriaeva-Korniyko ◽  
O.V. Kuleshov ◽  
Ya.A. Medrazhevska ◽  
L.O. Fik ◽  
T.D. Klets
Keyword(s):  
Heart Rate ◽  
Nervous System ◽  
Autonomic Nervous System ◽  
Mitral Valve ◽  
Frequency Domain ◽  
Mitral Valve Prolapse ◽  
Low Frequency ◽  
Very Low Frequency ◽  
Autonomic Nervous ◽  
Significant Difference

The article presents summarized materials on connective tissue dysplasia of the heart, primary mitral valve prolapse, dysfunction of the autonomic system. Aim of research: to estimate the condition of autonomic nervous system in children with primary mitral valve prolapse. We examined 106 children with mitral valve prolapse aged from 13 to 17 years old on the clinical base of city hospital “Center of mother and child” in Vinnitsya. Research included time and frequency domain (evaluation with cardiointervalography. Final results were compared with the control group records. The results showed no statistical significance among time domain parameters in the main group of children. All these indices displayed tendency to sympathetic and parasympathetic autonomic nervous system tonus increase in boys. However, sympathicotonia tendency was noted in girls only. Frequency domain parameters showed similar results, compared with the previous. Nevertheless, very low frequency parameters had statistically significant difference in both subgroups of patience with mitral valve prolapse, including males (3205.8±190.9 against 1717±154, р<0.05) and females (3280±220.1 against 1433±811, р<0.05). There were no statistically significant difference among other frequency domain parameters. Conclusions: we estimated that children with mitral valve prolapse have imbalanced autonomic homeostasis manifested by tone disturbances of both autonomic vegetative system branches with sympathetic predominance. Patients with primary mitral valve prolapse generally have increased sympathetic tone - both boys and girls - according to spectral analysis of heart rate variability indices, heart rate oscillation power of a very low frequency in particular (p<0.05). In children with mitral valve prolapse, the tone of parasympathetic nervous system is generally normal; there is a tendency to its increase in boys and decrease in girls. These children should be under close medical supervision by pediatricians and cardiologists.

Clinical and pathogen features of infective endocarditis:A retrospective study of 111 episodes in a teaching hospital in southwest China

2019 ◽  
Author(s):  
Yuanfang Wang ◽  
Mei Kang ◽  
Ya Liu ◽  
Siyin Wu ◽  
Weili Zhang ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Heart Disease ◽  
Infective Endocarditis ◽  
Laboratory Data ◽  
Clinical Manifestations ◽  
Resistance Rate ◽  
Native Valve ◽  
Duke Criteria ◽  
Preventive Medication ◽  
History Of

Abstract Background Infective endocarditis (IE) is a health-threaten infectious disease. Diverse and complicated etiology and causative microorganisms make IE difficult to diagnose and treat. As we know, current investigations of clinical and pathogen features of IE in West china are scarce. In this study, we aimed to investigate the epidemiology and pathogen characteristic of IE in our region. Methods A retrospective analysis of clinical and laboratory data was performed from all blood culture positive IE patients between 2012 to 2017 in Westchina Hospital of Sichuan University。The diagnosis is traditionally based on the modified Duke criteria. Results The mean age of the patient cohort was 40.7±21.5 years (ranging from 2-78); 73 cases (65.2%) were males and 39 cases (34.8%) were females. Of the 111 cases, 100 were native valve endocarditis (NVE) while 11 were prosthetic valve endocarditis (PVE), 87 cases (78.4%) were left-heart infection. Congenital heart disease (28.6%) and rheumatic heart disease (11.6%) were most common history of heart disease. Primary clinical manifestations were fever (87.5%) and heart murmur (78.6%).Streptococci spp (20.7%) was the most common organism, followed by Staphylococcus spp(17.9%). Streptococcus viridians showed no resistance to penicillin, erythromycin and clindamycin resistance rate were 47.4% and 40%. Benzocillin resistance rate of staphylococcus aureus to was 26.3%. Vancomycin or linezolid resistance staphylococcus aureus were not found. 75 patients died while 36 patients survived at last. With respect to risk factors, history of heart disease was the only prognostic risk factor (OR: 0.239, 95%CI 0.08-0.68) Conclusions Epidemiological and clinical characteristics of infective endocarditis are various and complex, distribution of pathogen is regional difference. Our research of infective endocarditis with bloodstream infection verified regional characteristics of infective endocarditis. The variations we observed in the study will be of important value to clinical preventive medication in our region.

scholarly journals Pulsed Levosimendan in advanced heart failure due to congenital heart disease: a case series

2020 ◽  
Vol 4 (3) ◽  
pp. 1-6
Author(s):  
James Cranley ◽  
Antonia Hardiman ◽  
Leisa J Freeman
Keyword(s):  
Heart Failure ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Case Series ◽  
Advanced Heart Failure ◽  
Good Evidence ◽  
Case Summary ◽  
Acute Decompensation

Abstract Background Levosimendan is a non-adrenergic calcium-sensitizing agent with positive inotropic and vasodilatory effects. Its use in acute decompensation of heart failure is established. Good evidence now exists for repetitive infusions of Levosimendan to improve symptoms and reduce hospitalization in advanced heart failure (AdHF) populations. Its use in heart failure resulting from congenital heart disease is not yet commonplace. Case summary We present three cases in which pulsed Levosimendan was used in the management of AdHF secondary to underlying congenital heart disease. There was symptomatic and biomarker evidence of improvement. Discussion Intermittent Levosimendan may represent a valuable therapy to reduce hospitalization and improve quality of life in adults with congenital heart conditions.

Mitral valve prolapse and infective endocarditis

1977 ◽  
Vol 63 (2) ◽  
pp. 215-222 ◽  
Author(s):  
Denton Corrigall ◽  
James Bolen ◽  
E.William Hancock ◽  
Richard L. Popp
Keyword(s):  
Infective Endocarditis ◽  
Mitral Valve ◽  
Mitral Valve Prolapse
Sign in / Sign up

Export Citation Format

Share Document