scholarly journals FEBRILE CONDITION IN 23-YEAR OLD PREGNANT WOMAN

2019 ◽  
Vol 34 (4) ◽  
pp. 921-924
Author(s):  
Asen Ivanov ◽  
Todor Gonovski ◽  
Hristo Stoev
Keyword(s):  
Infective Endocarditis ◽  
Mitral Valve ◽  
Fetal Death ◽  
Clinical Signs ◽  
Mitral Valve Regurgitation ◽  
Clonic Seizure ◽  
Anesthesia Induction ◽  
Complication Rates ◽  
Fetal Ultrasonography ◽  
Organ System Failure

A 23-year-old woman in her 29th gestation week of pregnancy was admitted in Obstetrics and Gynaecology Department with symptoms of fever, dyspnea and shortness of breath. The blood test examinations showed significant leukocytosis and elevated c-reactive protein levels. Transthoracic(TT) echocardiography was performed showing severe mitral valve regurgitation with posterior cusp destruction confirming the diagnosis of infective endocarditis. The condition of the patient significantly deteriorated, and she was urgently transferred to the Cardiovascular Surgery Department for an emergent surgical treatment. She was admitted in the Intensive Care Unit with clinical signs of severe septic shock and severe left heart insufficiency. A consultation of gynaecologist was performed and fetal death in utero from fetal ultrasonography was diagnosed. A decision for an emergent simultaneous operation was taken. During the anesthesia induction the patient developed severe circulatory shock needing a cardiopulmonary resuscitation which restored the spontaneous circulation after one minute. At first, before heparinization sectio parva was performed confirming the diagnosis of fetal death. During the cardiac operation after the cardiopulmonary bypass(CPB) institution, mitral valve replacement and inspection of the tricuspid valve was performed. The CPB was discontinued with three catecholamine support. In the postoperative period she was febrile with severe multiple organ system failure(MOSF) manifestation, generalized single tonic-clonic seizure and in the following hours three seizures with focal onset(muscle contractions in the right facial half) were observed. On the postoperative day(POD) 2 she developed clinical signs of blue discoloration of the distal phalanx of the left foot. Doppler ultrasound examination showed subtle pulsations on the left dorsal pedal artery. Ultrahemofiltration with antiseptic filter was performed for cytokine removal. In the following days the condition of the patient improved. She was extubated on POD 4, transferred to the post-operative department on POD 7 and discharged on POD 23. Despite advances in medicine, the treatment of the infective endocarditis is associated with high mortality and complication rates. Multidisciplinary collaboration is crucial for achieving the best outcome.

scholarly journals Triad of infective endocarditis, splenic abscess, and septicemia caused by Brucella melitensis

2017 ◽  
Vol 9 (04) ◽  
pp. 340-342 ◽  
Author(s):  
Shashank Purwar ◽  
Sharada C. Metgud ◽  
Shankar G. Karadesai ◽  
Mahantesh B. Nagamoti ◽  
Arathi Darshan ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Mitral Valve ◽  
Brucella Melitensis ◽  
Splenic Abscess ◽  
Mitral Valve Regurgitation ◽  
Atrioventricular Valve ◽  
Valve Regurgitation ◽  
Poor General Condition ◽  
Serological Tests ◽  
Grade Ii

AbstractA 40-year-old farmer from the district of North Karnataka who had received treatment for high fever of 8 days duration was admitted with fever, dyspnea, and poor general condition. Ultrasonography and echocardiogram revealed multiple splenic abscesses, vegetation on atrioventricular valve, aortic regurgitation (Grade I–II), and mitral valve regurgitation (Grade II–III), respectively. Brucella melitensis was detected in blood culture, and high titers of IgM and IgG anti-Brucella antibodies were observed in Brucella specific serological tests. The patient developed fulminant septicemia and succumbed due to multi-organ failure.

scholarly journals Cardiogenic and septic shock associated with aortic and mitral valve infective endocarditis caused by Abiotrophia Defectiva from a urinary tract infection

2018 ◽  
Vol 6 ◽  
pp. 2050313X1878770 ◽  
Author(s):  
Edward D Foley ◽  
Mohamed Ben Omran ◽  
Vaibhav Bora ◽  
Manuel R Castresana
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Infective Endocarditis ◽  
Mitral Valve ◽  
Tract Infection ◽  
Treatment Failure ◽  
Mitral Valve Regurgitation ◽  
Immunocompetent Patient ◽  
Septic Embolization ◽  
Abiotrophia Defectiva

Abiotrophia defectiva, also known as nutritionally variant streptococcus, is part of the normal flora of the oral cavity and urogenital and intestinal tracts and is a rare cause of infective endocarditis. It is fastidious or difficult to culture and associated with high rates of septic embolization, treatment failure and mortality. We describe an unusual presentation of infective endocarditis with severe mitral valve regurgitation due to Abiotrophia defectiva in an immunocompetent patient. After a complicated hospital course, surgical replacement of both the mitral and aortic valves was performed. We suggest that this patient likely had subacute infective endocarditis before diagnosis and treatment of her urinary tract infection, and following treatment failure, she developed life-threatening infective endocarditis. This case report highlights that patients with Abiotrophia defectiva infections are at high risk for infective endocarditis and that the clinical progression from this infection can be slow, with difficulty isolating the pathogen, which can significantly impact patient outcome.

scholarly journals Double valve replacement in a patient with Maroteaux – Lamy syndrome as an ultimate team challenge

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Alexandros Agron Demis ◽  
Stella Oikonomidou ◽  
Fotios Daglis ◽  
Spyridon Polymenakos ◽  
Matthew Panagiotou
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Aortic Root ◽  
Heart Valves ◽  
Severe Aortic Stenosis ◽  
Fiberoptic Bronchoscopy ◽  
Mitral Valve Regurgitation ◽  
Anesthesia Induction ◽  
Surgical Team ◽  
Double Valve Replacement

Abstract Background The Maroteaux-Lamy syndrome (Mucopolysaccharidosis type VI) is a rare, inherited metabolic disease that results in progressive tissue accumulation of dermatan-sulfated glycosaminoglycans and inflammatory consequences that almost always affects the heart valves. From the anesthesia point of view, managing the airway and ventilation might be a serious challenge due to specific features of the syndrome. Additionally, it is more than probable that the surgical team will perform a non-straightforward procedure. Case presentation A 42-year-old male with Maroteaux-Lamy syndrome was referred to our department with shortness of breath, due to severe aortic stenosis, and at least moderate mitral valve regurgitation. The patient was initially scheduled for aortic valve replacement. After multiple attempts with video assisted laryngoscopy, the endotracheal intubation was achieved with the aid of fiberoptic bronchoscopy, while the ventilation succeeded only with laryngeal mask. The somatic features of the syndrome that made the anesthesia induction extremely difficult, also affected the surgical procedure. Suboptimal exposure of the mitral valve, patch enlargement of the aortic root to host the bigger possible prosthesis, and the hard decision to replace the mitral valve even with a marginal indication were the intraoperative challenges for the surgical team. Finally, the patient underwent a successful double valve replacement with aortic root enlargement and 18 months postoperatively remains improved. Conclusion Patients with Maroteaux-Lamy syndrome represent a challenge for both anesthesiologists and cardiac surgeons. The whole team should be well prepared to deal with difficulties in airway management, ventilation and surgical valve exposure. The cardiac surgeon should be ready to offer additional procedures and even replace “prematurely” a moderately diseased valve in order to avoid a dangerous reoperation. The limited knowledge on the natural history of the Maroteaux-Lamy syndrome valvulopathy and the difficulties in anesthesia induction support this approach.

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