scholarly journals Infective Endocarditis Complicated with Progressive Heart Failure due to β-Lactamase-Producing Cardiobacterium hominis

2000 ◽  
Vol 38 (5) ◽  
pp. 2015-2017 ◽  
Author(s):  
Po-Liang Lu ◽  
Po-Ren Hsueh ◽  
Chien-Ching Hung ◽  
Lee-Jene Teng ◽  
Tsrang-Neng Jang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Infective Endocarditis ◽  
Aortic Valve ◽  
Blood Isolate ◽  
Severe Aortic Regurgitation ◽  
Progressive Heart Failure ◽  
Resistance To Penicillin ◽  
High Level ◽  
Level Resistance

We describe a 66-year-old woman with infective endocarditis due toCardiobacterium hominis whose condition, complicated by severe aortic regurgitation and congestive heart failure, necessitated aortic valve replacement despite treatment with ceftriaxone followed by ciprofloxacin. The blood isolate of C. hominis produced β-lactamase and exhibited high-level resistance to penicillin (MIC, ≧256 μg/ml) and reduced susceptibility to vancomycin (MIC, 8 μg/ml).

scholarly journals Dressler’s like pericarditis with pericardial effusion is the presenting feature of infective endocarditis

2018 ◽  
Vol 15 (1) ◽  
pp. 43-44
Author(s):  
Biswajit Majumder ◽  
Sharmistha Chatterjee ◽  
Rakesh Sarkar ◽  
Pritam Kumar Chatterjee
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Renal Failure ◽  
Infective Endocarditis ◽  
Pericardial Effusion ◽  
Aortic Valve ◽  
Medical Therapy ◽  
Surgical Intervention ◽  
Autoimmune Reaction ◽  
Pericardial Involvement

Summary: Infective Endocarditis (IE) being primarily the disease of valves and endocardium may occasionally be complicated with pericardial involvement in the form of pericarditis and pericardial effusion (PE). Pericarditis may be observed incidentally at the time of diagnosing IE and rarely does it remain the presenting feature of IE .The pericardial effusion may be attributed to ruptured aortic abscess extending into the pericardial space, autoimmune reaction, renal failure, HIV and congestive heart failure (CHF). Here we are presenting a 42 year old male having IE with vegetation in both mitral and aortic valve along with large sterile pericardial effusion was treated successfully by the medical therapy alone with favorable outcome. IE presenting with large exudative pericardial effusion being treated without any surgical intervention with substantial resolution of effusion has not been reported so far in medical literature.Nepalese Heart Journal 2017;12(2): 43-44.

Infective endocarditis by a rare and fastidious agent: Abiotrophia defectiva

2021 ◽  
Vol 14 (6) ◽  
pp. e241964
Author(s):  
Ana Margarida Mosca ◽  
Fenando Mané ◽  
Carla Marques Pires ◽  
Paulo Medeiros
Keyword(s):  
Infective Endocarditis ◽  
Aortic Valve ◽  
Blood Cultures ◽  
Surgical Aortic Valve Replacement ◽  
Delay In Diagnosis ◽  
Severe Aortic Regurgitation ◽  
Appropriate Treatment ◽  
Abiotrophia Defectiva ◽  
High Level ◽  
Prompt Diagnosis

Abiotrophia defectiva is a nutritional variant streptococcus, with affinity for endovascular structures that cannot be cultured on non-supplemented media, leading to a delay in diagnosis. This case describes a 36-year-old woman with a previously known bicuspid aortic valve that presented with asthenia, myalgias and anorexia with 2-month onset. On admission, we documented fever and a systolic murmur. Transthoracic echocardiography revealed an oscillating mass attached to the aortic valve. The patient was admitted with a possible diagnosis of infective endocarditis. Later, blood cultures were positive for A. defectiva. Due to severe aortic regurgitation and congestive heart failure, she underwent surgical aortic valve replacement. After 6 weeks of antimicrobial therapy, the patient experienced full recovery. Despite of its rarity, A. defectiva endocarditis is associated with significant morbidity with mortality and physicians must have a high level of suspicion to ensure a prompt diagnosis and provide the appropriate treatment.

scholarly journals Aortic valve replacement due to granulomatosis with polyangiitis: a case series

2020 ◽  
Vol 4 (5) ◽  
pp. 1-6
Author(s):  
Gilles Uijtterhaegen ◽  
Laura De Donder ◽  
Eline Ameloot ◽  
Kristof Lefebvre ◽  
Jo Van Dorpe ◽  
...  
Keyword(s):  
Heart Disease ◽  
Infective Endocarditis ◽  
Aortic Valve ◽  
Valve Replacement ◽  
Valvular Heart Disease ◽  
Granulomatosis With Polyangiitis ◽  
Surrounding Tissue ◽  
Valve Regurgitation ◽  
Aortic Valve Regurgitation ◽  
Severe Aortic Regurgitation

Abstract Background Granulomatosis with polyangiitis (GPA), formerly known as Wegener’s granulomatosis, is a systemic inflammatory process predominantly affecting upper and lower respiratory tract and kidneys. Valvular heart disease is a rare manifestation of GPA. Case summary We report two cases of acute valvular heart disease mimicking acute endocarditis caused by GPA. Both patients were middle-aged females with acute aortic valve regurgitation suggestive of possible infective endocarditis. In their recent medical history, atypical otitis and sinusitis were noted. The first patient was admitted with heart failure and the second patient because of persisting fever. Echocardiogram revealed severe aortic regurgitation with an additional structure on two cusps, suggestive of infective endocarditis in both patients. Urgent surgical replacement was performed; however, intraoperative findings did not show infective endocarditis, but severe inflammatory changes of the valve and surrounding tissue. In both patients, the valve was replaced by a prosthetic valve. Microscopic examination of the valve/myocardial biopsy showed diffuse acute and chronic inflammation with necrosis and necrotizing granulomas, compatible with GPA after infectious causes were excluded. Disease remission was obtained in both patients, in one patient with Rituximab and in the other with Glucocorticoids and Cyclophosphamide. Both had an uneventful follow-up. Discussion Granulomatosis with polyangiitis can be a rare cause of acute aortic valve regurgitation mimicking infective endocarditis with the need for surgical valve replacement. Atypical ear, nose, and throat symptoms can be a first sign of GPA. Symptom recognition is important for early diagnosis and appropriate treatment to prevent further progression of the disease.

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.

scholarly journals Overexpression of the MtrC-MtrD-MtrE Efflux Pump Due to an mtrR Mutation Is Required for Chromosomally Mediated Penicillin Resistance in Neisseria gonorrhoeae

2002 ◽  
Vol 184 (20) ◽  
pp. 5619-5624 ◽  
Author(s):  
Wendy L. Veal ◽  
Robert A. Nicholas ◽  
William M. Shafer
Keyword(s):  
Neisseria Gonorrhoeae ◽  
Base Pair ◽  
Efflux Pump ◽  
Penicillin Resistance ◽  
Single Base ◽  
Base Pair Deletion ◽  
Resistance To Penicillin ◽  
Single Base Pair ◽  
High Level ◽  
Level Resistance

ABSTRACT The importance of the mtrCDE-encoded efflux pump in conferring chromosomally mediated penicillin resistance on certain strains of Neisseria gonorrhoeae was determined by using genetic derivatives of penicillin-sensitive strain FA19 bearing defined mutations (mtrR, penA, and penB) donated by a clinical isolate (FA6140) expressing high-level resistance to penicillin and antimicrobial hydrophobic agents (HAs). When introduced into strain FA19 by transformation, a single base pair deletion in the mtrR promoter sequence from strain FA6140 was sufficient to provide high-level resistance to HAs (e.g., erythromycin and Triton X-100) but only a twofold increase in resistance to penicillin. When subsequent mutations in penA and porIB were introduced from strain FA6140 into strain WV30 (FA19 mtrR) by transformation, resistance to penicillin increased incrementally up to a MIC of 1.0 μg/ml. Insertional inactivation of the gene (mtrD) encoding the membrane transporter component of the Mtr efflux pump in these transformant strains and in strain FA6140 decreased the MIC of penicillin by 16-fold. Genetic analyses revealed that mtrR mutations, such as the single base pair deletion in its promoter, are needed for phenotypic expression of penicillin and tetracycline resistance afforded by the penB mutation. As penB represents amino acid substitutions within the third loop of the outer membrane PorIB protein that modulate entry of penicillin and tetracycline, the results presented herein suggest that PorIB and the MtrC-MtrD-MtrE efflux pump act synergistically to confer resistance to these antibiotics.

scholarly journals Major Aortic Reconstruction with the Replacement of Supra-Aortic Branches: Successful Surgical Treatment of Takayasu Arteritis Initially Presented as Congestive Heart Failure

Diagnostics ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 216
Author(s):  
Maja Stojanovic ◽  
Sanvila Raskovic ◽  
Marija Boricic-Kostic ◽  
Vesna Bozic ◽  
Maja Vuckovic ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Takayasu Arteritis ◽  
Morphological Changes ◽  
Pulmonary Arteries ◽  
Uneventful Recovery ◽  
Severe Aortic Regurgitation ◽  
Bentall Procedure ◽  
One Year ◽  
Arch Reconstruction

Takayasu arteritis (TA) is a rare, large vessel vasculitis that affects aorta, its major branches, and occasionally pulmonary arteries. Patients with TA can present with constitutional features and/or various symptoms and signs caused by morphological changes in the blood vessels affected by the inflammatory process. Corticosteroids (CS) and immunosuppressives (IS) are the first line treatment for active TA. Open surgery remains a treatment of choice for TA patients with moderate-to-severe aortic regurgitation (AR) and ascending aortic aneurysm (AAA). We present a 26-year-old female diagnosed with an advanced stage of TA, initially presented as congestive heart failure. Due to a progressive course of the disease (AR 3+, AAA 5.5 cm), surgery of the Aortic valve and root (Bentall procedure), with total arch reconstruction and replacement of supra-aortic branches was performed. The patient has had an uneventful recovery during the postoperative course with no complications at one year follow-up. Normal left ventricle (LV) diameter, LV ejection fraction 67%, and a trace of AR were seen on the last echocardiography.

scholarly journals P249 Iatrogenic aortic cusp laceration causing severe acute traumatic aortic regurgitation secondary to complex percutaneous coronary intervention using rotablator;3DTEE-anatomic correlates

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
V Vadgaonkar ◽  
H Tarief ◽  
S Shivappa ◽  
L Sulaibikh ◽  
S Saif ◽  
...  
Keyword(s):  
Heart Failure ◽  
Aortic Valve ◽  
Aortic Regurgitation ◽  
High Speed ◽  
Past History ◽  
Case Reports ◽  
Free Margin ◽  
Severe Aortic Regurgitation ◽  
Percutaneous Coronary ◽  
Coronary Cusp

Abstract Clinical case 59 years old male known case of long standing diabetes and dyslipidemia presented to our institute with Non-STEMI.His past history was significant for multiple admissions with acute coronary syndromes and percutaneous coronary interventions(PCI). Echocardiogram in this presentation showed preserved biventricular systolic function with no valvulopathies. He was taken up for coronary angiogram which showed significant calcified angulated lesion in LAD/LCX(Left anterior descending and circumflex) with diffuse disease in Ramus/RCA. Mode of revascularisation was discussed in detail with the patient for Rotablation-guided PCI to LAD/LCX vs CABG.He preferred and underwent complex PCI to LAD. During the procedure he developed acute heart failure which was managed conservatively. Immediate TTE showed new severe aortic regurgitation(AR) with probable left coronary cusp(LCC) perforation and preserved LVEF.After stabilization, he was scheduled for TEE which showed tear in the LCC with complex fragmented jet of holodiastolic AR filling the entire LVOT.There was new late diastolic to early systolic MR.3DTEE Enface view of the aortic valve was evident of ovoid shaped laceration in LCC extending till the free margin (Fig 1C). There were additional tears in Non-coronary cusp(NCC) extending till the free margin of right coronary cusp(RCC).3DTEE colour was notable for regurgitant jet origin from LCC/NCC (Fig 2B). Based on above findings,He was offered aortic valve intervention but was reluctant initially.He presented 2 months later with exertional dyspnoea, mild LV dilatation and drop in LVEF to 50%.He consented for surgery and underwent bioprosthetic Aortic valve replacement because of extensive cusp tear and deformation of the valve along with complete revascularisation of the remaining diseased coronaries.Post-operative course was complicated by vasoplegic arrest and acute renal failure which was successfully managed conservatively. Discussion We report this case for the rarity of this post-PCI iatrogenic complication and the incremental role of 3DTEE in identifying the exact pathology.It was proposed that during PCI multiple stalling of rotatbur in calcified LAD caused traction and eventually disengagement of guide causing rotabur to freely hang in ascending aorta close to the cusps.Possibly this rotablator with very high speed(180000rpm) would have momentarily come in contact with the aortic cusps causing cuspal perforation and heart failure in Cath lab.3DTEE correlated very well with the anatomo-pathology and matched with intraoperative finding as shown in figures 2A & 2C.These findings prior to aortic cross clamp could significantly reduce time of surgery as he had an additional CABG procedure to be performed.There are few isolated case reports of post PCI aortic valve perforation but probably ours is the first one secondary to the use of rotablator with near involvement of all the cusps and reasonably accurate 3DTEE-anatomic characterisation. Abstract P249 Figure.

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