Splenic rupture as the presenting symptom in infective endocarditis: a rare and dangerous complication

2021 ◽  
Vol 14 (9) ◽  
pp. e244191
Author(s):  
Gautam Sen ◽  
Susan Lewis
Keyword(s):  
Infective Endocarditis ◽  
Mitral Valve ◽  
Splenic Rupture ◽  
Rare Complication ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Emergency Laparotomy ◽  
Mitral Valve Leaflet ◽  
Risk Patients ◽  
History Of

Infective endocarditis remains a dangerous condition and carries a mortality risk of approximately 20%. Splenic rupture is a rare complication of endocarditis. A 60-year-old woman with a history of atrial fibrillation, mitral valve repair and severe mitral regurgitation was admitted with a fall and abdominal pain. Emergency laparotomy was performed leading to a diagnosis of splenic rupture, for which splenectomy was performed. Four months later, the patient represented with symptoms of a transient ischaemic attack. Transthoracic and transoesophageal echocardiogram confirmed a large vegetation on the anterior mitral valve leaflet. Treatment with antibiotics and re-do mitral valve surgery was performed. The cause of the initial splenic rupture was felt to have been secondary to undiagnosed infective endocarditis. It is imperative to consider endocarditis in a case of spontaneous splenic rupture particularly in high-risk patients such as those with previous valve surgery.

scholarly journals Contemporary Mitral Valve Surgery for Septuagenarians and Octogenarians

2017 ◽  
Vol 4 (1) ◽  
pp. 1-8
Author(s):  
Yi-Wen B. Liao ◽  
Tom K.M. Wang ◽  
Sophie Harmos ◽  
Tharumenthiran Ramanathan ◽  
Peter Ruygrok
Keyword(s):  
Mitral Valve ◽  
Operative Mortality ◽  
Age Groups ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Risk Scores ◽  
Safe Procedure ◽  
City Hospital ◽  
Mortality And Morbidity ◽  
Risk Patients

Background: The increasing prevalence of degenerative and functional mitral valve disease as the population ages alongside introduction of percutaneous mitral valve interventions mandates revision of outcomes of mitral valve surgery (MVS) in elderly and high risk patients. We compared the characteristics and outcomes of octogenarians and septuagenarians undergoing MVS. Methods: All patients over 70 years of age having isolated MVS at Auckland City Hospital during 2005-2012 were studied and divided into 70-79 and >80 years age-groups for analysis. Results: There were 20 octogenarians and 81 septuagenarians studied. Apart from median age (82.0 vs. 74.0 years, P<0.001) and previous stroke (15.0% vs. 1.2%, P=0.024) respectively, there were no significant differences in pre-operative characteristics. Octogenarians however had significantly higher median EuroSCORE (4.5% vs. 3.4%, P=0.010) and STS Score (5.6 vs. 2.8%, P=0.002). Despite this, octogenarians had numerically but not statistically significantly less operative mortality (0.0% vs. 7.4%, P=0.340). One, three and five-year survivals were 100.0%, 80.0% and 70.0% for octogenarians and 91.4%, 86.4% and 73.8% septuagenarians. There was also no difference in composite and individual post-operative complications including stroke (P=0.358-1.000). The only independent predictor of operative mortality was cardiopulmonary bypass time odds ratio 1.02, 95% confidence interval 1.00-1.04, P=0.044. Conclusion: Although octogenarians were older with higher risk scores, they did not have increased mortality and morbidity from MVS. MVS remains a safe procedure in selected octogenarians, and other factors beyond age and risk scores such as frailty would be important in deciding the modality of mitral valve intervention in elderly patients.

scholarly journals The natural history of aortic valve disease after mitral valve surgery

1999 ◽  
Vol 33 (7) ◽  
pp. 2003-2008 ◽  
Author(s):  
Mordehay Vaturi ◽  
Avital Porter ◽  
Yehuda Adler ◽  
Yaron Shapira ◽  
Gideon Sahar ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Aortic Valve ◽  
Natural History ◽  
Aortic Valve Disease ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Valve Disease ◽  
History Of

Minimally Invasive Mitral Valve Surgery in Truly High-Risk Patients: Are We Pushing the Boundaries? An Observational Study

2015 ◽  
Vol 10 (5) ◽  
pp. 328-333 ◽  
Author(s):  
Marco Moscarelli ◽  
Rafik Margaryan ◽  
Alfredo Cerillo ◽  
Enkel Kallushi ◽  
Pierandrea Farneti ◽  
...  
Keyword(s):  
High Risk ◽  
Mitral Valve ◽  
Minimally Invasive ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Tricuspid Valve Repair ◽  
Discrimination Power ◽  
High Risk Patients ◽  
Risk Patients

Objective This study aimed to assess in a retrospective series of truly high-risk patients who underwent minimally invasive mitral valve surgery: (1) postoperative and long-term results and (2) logistic EuroSCORE and EuroSCORE II discrimination power. Methods Between 2003 and 2013, we reviewed in our institution patients who underwent minimally invasive mitral valve surgery with or without tricuspid valve repair via right minithoracotomy with logistic EuroSCORE of 20 or higher. Results Among a total number of 1604, 88 patients were identified. Median logistic and EuroSCORE II was 27.29 (interquartile range, 15.3) and 12.7% (11.3%), respectively. Mean (SD) age was 71.9 (8.4) years; 42 were female (47.7%); 60 patients (68.1%) underwent previous sternotomy. Mitral valve was replaced in 59 (67%) and repaired in 29 (32.9%) patients; tricuspid valve repair was performed in 23 patients (26.1%). Median cardiopulmonary bypass and cross-clamp times were 157 minutes (interquartile range, 131–187 minutes) and 83 minutes (81–116 minutes), respectively; conversion to sternotomy and reopening for bleeding was necessary in 4 (4.5%) and 3 (3.4%) patients; permanent and transient neurological injuries were reported in 6 (6.8%) and 3 (3.4%) patients; acute kidney injury was reported in 13 patients (14.7%); 15 patients (17%) had pulmonary complications. Ten patients died while in the hospital (11.2%). Survival at 6 years was 78% (95% confidence interval, 69–88). Conclusions In this series of truly high-risk patients, minimally invasive mitral surgery was associated with acceptable early mortality and morbidity as well as long-term outcomes; both logistic and EuroSCORE II showed suboptimal discrimination power.

OC42 MINIMALLY INVASIVE MITRAL VALVE SURGERY IN HIGH-RISK PATIENTS

2018 ◽  
Vol 19 ◽  
pp. e4
Author(s):  
E. Cura Stura ◽  
D. Ricci ◽  
G. Marchetto ◽  
C. Barbero ◽  
S. El Qarra ◽  
...  
Keyword(s):  
High Risk ◽  
Mitral Valve ◽  
Minimally Invasive ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
High Risk Patients ◽  
Risk Patients

Minimally Invasive Mitral Valve Surgery for Mitral Valve Infective Endocarditis

2017 ◽  
Vol 66 (07) ◽  
pp. 525-529 ◽  
Author(s):  
Joerg Seeburger ◽  
Jens Garbade ◽  
Uta Schon ◽  
Martin Misfeld ◽  
Friedrich Mohr ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Mitral Valve ◽  
Minimally Invasive ◽  
Mitral Annulus ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Mitral Leaflet ◽  
Minimally Invasive Approach ◽  
Invasive Approach

Background The feasibility of minimally invasive mitral valve (MV) surgery in infective endocarditis (IE) has not been reported in detail. We assessed the safety, efficacy, and durability of the minimally invasive approach through a right anterolateral minithoracotomy for surgical treatment of MV IE. Methods A review of the Leipzig Heart Center database revealed 92 eligible patients operated on between 2002 and 2013. All patients had undergone minimally invasive surgery for IE. The indication for surgery was isolated IE of the MV in all patients. Baseline and intraoperative data, as well as clinical outcomes and short-term follow-up were analyzed retrospectively. Results The patients' mean age was 60.9 ±  15.3 years, the logistic EuroSCORE II was 19.6 ± 19.1%, and 64.1% (59) were male. MV repair was feasible in 23.9% (22/92) of patients. Repair techniques included annuloplasty ring implantation, anterior mitral leaflet resection, posterior mitral leaflet resection, and implantation of neochordae. MV replacement was performed in 69 patients (75%), a mitral annulus patch in 1 patient, and concomitant tricuspid valve surgery for tricuspid regurgitation in 5 patients. Bacteriological analysis showed staphylococcus infection in 45.5%, streptococcus in 36.4%, enterococcus in 13.6%, and others in 4.5%. The 30-day-mortality rate was 9.8% (9 patients). The 1-year follow-up showed a 1-year survival rate of 77.7 ± 4.4% and freedom from reoperation within 1 year due to reendocarditis of 93.3 ± 2.1%. Conclusions The minimally invasive approach is suitable for the treatment of IE of the MV. It is a good technique in IE in selected patients.

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