Reconstruction of a Previously Repaired Aortic Valve Destroyed by Infective Endocarditis: Case Report

Infective endocarditis (IE) is an uncommon condition among patients with congenital heart disease, however it can be life threatening. The usual management includes replacement of the affected valve, especially in patients with aortic valve compromise, and is even more common in previously repaired valves. In this case report, we describe the successful reconstruction of an aortic root destroyed by IE, in a patient with history of ballooning of a congenital aortic stenosis.

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Coxiella Endocarditis as the Cause of Recurrent Fever and Brain Abscess in a Patient with Complex Congenital Heart Disease: A Case Report and Literature Review

Case Reports in Infectious Diseases ◽

10.1155/2020/7894574 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Ioannis A. Ziogas ◽

Alexandros P. Evangeliou ◽

Olga Tsachouridou ◽

Alexandra Arvanitaki ◽

Afroditi Tsona ◽

...

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Case Report ◽

Congenital Heart ◽

Diagnostic Delay ◽

Unknown Origin ◽

Recurrent Fever ◽

Complex Congenital Heart Disease ◽

Empiric Antibiotic ◽

Life Threatening

Introduction. Blood culture-negative infective endocarditis (BCNIE) can present subtly and is associated with a diagnostic delay leading to increased morbidity and mortality. Case Report. We present the case of an 18-year-old male with a history of complex congenital heart disease and 3-year intermittent episodes of fever of unknown origin, who was referred to our hospital for upper and lower extremity focal seizures. Laboratory blood tests were normal, blood cultures were negative, and brain imaging revealed an abscess. Cardiology consultation was requested, and transthoracic echocardiography revealed an intracardiac vegetation. Empiric antibiotic treatment with sultamicillin, gentamycin, and meropenem was initiated. Serology testing was positive for Coxiella burnetii, and the diagnosis of BCNIE was established. The antibiotic course was changed to oral doxycycline for 36 months and led to resolution of IE, with no vegetation detected on TTE after 15 months. Conclusion. BCNIE is a life-threatening disease entity that can lead to severe complications, such as valve regurgitation, emboli, and death. Patients with congenital heart disease are particularly vulnerable to IE. Timely diagnosis and antibiotic management are of paramount importance in order to avoid the potentially fatal sequelae.

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Transcatheter Aortic Valve Replacement in a Pediatric Patient With a History of Congenital Heart Disease and Recent Post-Procedure Decompensation

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2020.05.002 ◽

2020 ◽

Vol 34 (12) ◽

pp. 3385-3389

Author(s):

Adam R. McKinney ◽

Jacob B. Meers

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Pediatric Patient ◽

Transcatheter Aortic Valve Replacement ◽

Congenital Heart ◽

Transcatheter Aortic Valve ◽

Post Procedure ◽

History Of

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Abstract 15592: Role of Electroanatomic Voltage Mapping for Risk Stratification in Patients With Repaired Congenital Heart Disease Involving the Right Ventricle

Circulation ◽

10.1161/circ.132.suppl_3.15592 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Vincenzo Pazzano ◽

Rosalinda Palmieri ◽

Corrado Di Mambro ◽

Mario S Russo ◽

Massimo S Silvetti ◽

...

Keyword(s):

Risk Factors ◽

Congenital Heart Disease ◽

Heart Disease ◽

Congenital Heart ◽

Low Voltage ◽

Scar Tissue ◽

Adult Patients ◽

Surface Ecg ◽

Life Threatening ◽

History Of

Introduction: Among adult patients with previous surgical correction for Tetralogy of Fallot or other repaired Congenital Heart Disease (rCHD) involving the RV, ventricular arrhythmias (VA) and sudden cardiac death (SCD) represent a late complication. The imparied haemodynamics that lead to RV dilatation and overload could also alterate its electroanatomic structure. Hypothesis: 3D electroanatomic mapping (EAM) of the RV could confirm the presence of myocardial electrical abnormalities, allowing to better identify patients at risk for life-threatening arrhythmias. Methods: 146 patients (age 19.2 ±7.0) with rCHD involving the RV were selected from a population undergoing routine post-surgical follow-up, according to the presence of VA or severe RV dilatation. These patients underwent 3D EAM of the RV. We tested the correlation between size of scar tissue (areas with voltage < 0.5 mV) and several parameters universally accepted by the literature as risk factors for VA in this particular patient population. Results: In 125 (85.6%) patients, EAM demonstrated areas of low voltage in the antero-lateral RVOT. In 20 of these (16%, 13.7% of the total) the scar extended to the septum. 72 (49.3%) had a peritricuspid scar, and in 20 (13.7%) other areas of the RV were interested. Total low-voltage area, expressed as % of total endocardial area, was significantly higher in patients with history of PVCs [3.2% (±2.6) vs 2.2% (±1.8), p<0.05], complex PVCs at 24h-Holter ECG (Lown class ≥2) [3.4 (±2.5) vs 2.6 (±2.3), p<0.05], exercise-inducible PVCs [3.8 (±2.4) vs 2.6 (±2.2), p=0.01] and history of previous shunt [4.0 (±2.7) vs 2.6 (±2.2), p=0.01]. Scar size was also positively correlated with age (p=0.01), age at correction (p=0.01) and QRS duration on surface ECG (p<0.05). Conclusions: In patients with rCHD involving the RV it is common to observe endocardial low-voltage areas with variable distribution, not always corresponding to the sites of surgical lesion. Morover, the size of the scar tissue area correlates with some of the parameters which have been already identified as risk factors for life-threatening arrhythmias and SCD in adult patients with CHD. We suggest that EAM should become part of the routine tests for the stratification of arrhythmic risk in this population.

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Infective endocarditis of partial atrioventricular septal defect: A case report

Vojnosanitetski pregled ◽

10.2298/vsp171005116s ◽

2020 ◽

Vol 77 (6) ◽

pp. 657-660

Author(s):

Maja Stefanovic ◽

Ilija Srdanovic ◽

Aleksandra Milovancev ◽

Stamenko Susak ◽

Snezana Tadic ◽

...

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Case Report ◽

Infective Endocarditis ◽

Right Ventricle ◽

Tricuspid Valve ◽

Congenital Heart ◽

Septal Defect ◽

Atrioventricular Septal Defect ◽

Mitral Leaflet

Introduction. Partial atrioventricular septal defect (AVSD) is a form of congenital heart disease (CHD) rarely detected in adults. Infective endocarditis represents a severe complication that carries a substantial risk. Case report. We here reported a case of a 43-year-old female with previously diagnosed adult CHD (partial AVSD and bicuspid aortic valve) presented to the hospital with fever and malaise 14 days prior to admission. On the lung computed tomography scan inflammatory consolidations were found and dual antibiotic therapy (ceftazidime and clarithromycin) was administered without significant regression of pulmonary inflammatory consolidations. The antibiotic treatment was continued with amoxicillin/clavulanic acid combined with levofloxacin and metronidazole. Transthoracic and transesophageal echocardiography revealed a large vegetation (dimension, 3.6 x 1.8 cm) attached to the septal leaflet of the tricuspid valve floating between right atrium and right ventricle through tricuspid valve with high embolic potential. Endocarditis team reached a decision for immediate surgical intervention. The operative findings revealed the partial AVSD, common atrioventricular valve with cleft of the anterior mitral leaflet in the A2 segment and detached and cleft septal leaflet of the tricuspid valve. Vegetation (size 4 x 3 cm) was attached to the septal side of the tricuspid annulus, basal segment of the anterior mitral leaflet and edge of the atrial septal defect freely floating between right atrium, right ventricle and left atrium. Excision of the vegetation and AVSD plastics were done, as well as the reconstruction of the mitral and tricuspid annuli and leaflets. The treatment was continued with antibiotics and completed in 18 days with full recovery. Conclusion. Early and precious diagnosis and optimal management that combines both conventional and surgical approaches are crucial for reducing the risk of complications and mortality in patients with infective endocarditis in grown-up congenital heart disease.

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Pseudoaneurysm of the sinus of Valsalva caused by infective endocarditis in a 7-year-old child with congenital heart disease

Cardiology in the Young ◽

10.1017/s1047951121001128 ◽

2021 ◽

pp. 1-3

Author(s):

Wataru Kashimada ◽

Tao Fujioka ◽

Jotaro Kobayashi

Keyword(s):

Congenital Heart Disease ◽

Infective Endocarditis ◽

Aortic Valve ◽

Trisomy 21 ◽

Congenital Heart ◽

Septal Defect ◽

Subaortic Stenosis ◽

Sinus Of Valsalva ◽

History Of ◽

Patch Closure

Abstract We report a case of a pseudoaneurysm in the sinus of Valsalva, secondary to infective endocarditis in a child with trisomy 21. The patient had a history of subaortic stenosis, bicuspid aortic valve, and ventricular septal defect. Patch closure of the ostium of the pseudoaneurysm and aortic valve replacement was performed. The patient was discharged without severe complications.

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