scholarly journals Right-sided infective endocarditis complicating central venous line insertion: a case report

2019 ◽  
Vol 1 (1) ◽  
pp. 19-22
Author(s):  
Aram Mirza ◽  
Kawa Hassan ◽  
Farman Ahmed
Keyword(s):  
Infective Endocarditis ◽  
Heart Surgery ◽  
Guide Wire ◽  
Artery Bypass ◽  
White Blood Cells ◽  
Open Heart Surgery ◽  
Central Venous Line ◽  
Central Venous ◽  
Reactive Protein ◽  
Valve Tissue

Abstract Infective endocarditis is a serious and potentially fatal complication of central venous line (CVL) placement in patients with diseased hearts. A man of 59 was admitted because of fever and dyspnea of 5 days duration. He was a known case of ischemic cardiomyopathy with frequent admissions to a local hospital. Two months earlier, a CVL was placed in right subclavian vein for drug administration. On examination, he was febrile and hypotensive with a systolic murmur in tricuspid and mitral areas. CVL- guide wire was radiographically visible. White blood cells and C-reactive protein were elevated. Echocardiography showed big vegetation on tricuspid valve (TV), severe mitral and tricuspid regurgitation and dilated left ventricle whilst coronary angiography revealed 3-vessel disease. Antibiotic therapy was followed by an open heart surgery during which the guide wire and valve vegetation were removed, TV was repaired, mitral valve was replaced and coronary artery bypass grafting was performed. Culture of blood, valve tissue and guide wire grew Staphylococcus Epidermidis. Despite intensive medical and surgical therapy, the patient succumbed on the 4th postoperative day.

scholarly journals P1474 Right or left; which sided the infective endocarditis is?

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A A Baskurt ◽  
E Ozpelit ◽  
Z Kumral ◽  
B Akdeniz
Keyword(s):  
Infective Endocarditis ◽  
Aortic Root ◽  
Right Atrium ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Transoesophageal Echocardiography ◽  
Right Atrial ◽  
Replacement Surgery ◽  
Reactive Protein ◽  
The Right

Abstract ABSTRACT Treatment and management of infective endocarditis (IE) depends on the side of involvement. Involvement of both sides of heart is rarely encountered. We describe one case of both sided infective endocarditis caused by staphylococcus auerus. In this case, the vegetation is thought to be on the right side of the heart at first examination by transthrorasic echocardiography (TTE). However; when examined more carefully with transoesophageal echocardiography (TEE), nothing was as it seemed. CASE PRESENTATİON A 86-year-old woman, who underwent mechanic aortic valve replacement surgery 11 years before, was admitted to emergency room with fever, dispnea and cough. Physical examination showed a temperature of 38.6. Electrocardiography showed a atrial fibrillation of 112 beats/min. Laboratory tests revealed an elevated C reactive protein of 211 mg/l. The patient was empirically treated with intravenous piperacillin-tazobactam and teicoplanin, by the recommendation of infection disease unit. Staphylococcus aureus grew in both bottles of blood cultures. A TTE showed severe tricuspid regurgitation with vegetation, mild aortic regurgitation and moderate mitral regurgitation with no clear vegetation. We decided perform TEE and realised the vegetation in the right atrium was originated from the right atrial wall not from the tricuspid valve. Then we also noticed a thickening in the walls of aortic root with systolic expansion. This finding was consistent with paraaortic abscess formation. The 3D TEE examination helped us to understand the origin of the vegetation in the right atrium. Because the wall of the right atrium which the vegetation arised from was in direct continuity with the infected aortic root. We conclude that the paraortic abscess was spread to the right atrium by neighborhood. After one week of IV antibiotics treatment, the patient undergone open heart surgery. The surgical inspection confirmed the echocardiographic diagnosis. DISCUSSION Echocardiography helps us in diagnosis, determination of side of involvement, and complications of infective endocarditis. Usually the endocarditis invole only one side of the heart: left or right. We have found only four cases of double-sided endocarditis in literature. Our case is the first one , in which we describe a direct extension of aortic root abscess to the right atrium. Abstract P1474 figure 1

scholarly journals The Role of Inflammation in Atrial Fibrillation following Open Heart Surgery

2008 ◽  
Vol 36 (5) ◽  
pp. 1070-1076 ◽  
Author(s):  
S Canbaz ◽  
H Erbas ◽  
S Huseyin ◽  
E Duran
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Systemic Inflammation ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Open Heart Surgery ◽  
Vascular Cell Adhesion ◽  
Reactive Protein ◽  
Mediastinal Drainage

This study investigated the role of systemic inflammation in the development of atrial fibrillation (AF) after coronary artery bypass grafting (CABG). CABG was performed using cardiopulmonary bypass in 77 patients. Pre-operative AF was present in six patients (7.8%) and post-operative AF developed in 13 (18.3%) of the 71 patients with pre-operative sinus rhythm. Post-operative mediastinal drainage was significantly increased in patients with post-operative AF compared with those with sinus rhythm. Plasma E-selectin, P-selectin and vascular cell adhesion molecule levels were not significantly different between patients with pre- and post-operative sinus rhythm, those with pre-operative sinus rhythm and post-operative AF, and those with pre- and post-operative AF. There were significant differences between pre-and post-operative C-reactive protein, interleukin (IL)-6 and IL-10 levels within all three groups, but no differences in these parameters between the groups. Thus, in all groups there were significant alterations in mediators indicative of systemic inflammation following CABG, but comparisons between the groups revealed no differences predictive of AF.

Comparison of the effects of centrifugal versus roller pump on the immune response in open-heart surgery

Perfusion ◽  
1995 ◽  
Vol 10 (4) ◽  
pp. 249-256 ◽  
Author(s):  
J. Perttilä ◽  
M. Salo ◽  
O. Peltola
Keyword(s):  
Immune Responses ◽  
Centrifugal Pump ◽  
Coronary Artery Bypass Surgery ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Open Heart Surgery ◽  
Pokeweed Mitogen ◽  
C Reactive Protein ◽  
Roller Pump ◽  
Reactive Protein

We compared the effects of a centrifugal pump with those of a roller pump on immune responses in 26 coronary artery bypass surgery patients during cardiopulmonary bypass (CPB). The patients were randomly allocated into a (Biomedicus) centrifugal pump group and a (Stöckert) twin roller pump group. Leucocyte and differential counts; percentages of lymphocyte subpopulations (CD3-, CD4-, CD8-, CD16-, CD20- and CD25-positive lymphocytes) and monocytes (CD14); phytohaemagglutinin-, concanavalin A-, and pokeweed mitogen-induced and unstimulated proliferation of separated lymphocytes; unstimulated and pokeweed mitogen-stimulated production of IgG, IgM, or IgA; and plasma fibronectin, C-reactive protein and serum albumin concentrations were measured preoperatively, immediately before CPB, immediately before aortic declamping and on the first postoperative morning. Significant changes were seen in these variables, but no differences occurred between the groups.

scholarly journals Effect of Alpha-Lipoic Acid on Atrial Fibrillation after Open Heart Surgery

2020 ◽  
Author(s):  
Wael Elfeky ◽  
Dalia R El-Afify
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Lipoic Acid ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Open Heart Surgery ◽  
Group Versus ◽  
Control Group ◽  
Alpha Lipoic Acid ◽  
Reactive Protein

Background: Postoperative atrial fibrillation (POAF) is associated with increased morbidity and mortality, and an inflammatory process is involved in its pathogenesis. We aimed to study the possible effect of alpha-lipoic acid (ALA) as an antioxidant on atrial fibrillation after cardiac surgery. Methods: The study included ninety patients who underwent cardiac surgery, either valvular or coronary artery bypass grafting using cardiopulmonary bypass, and were randomized into two groups: Control and ALA groups. Blood samples were obtained to measure preoperative and postoperative levels of malondialdehyde (MDA), glutathione, C-reactive protein (CRP) and interleukin-6 (IL-6). The patients were monitored for the occurrence of atrial fibrillation until the day of discharge. Results: POAF occurred in 33% in the control group versus 11% in the ALA group (p=0.011).  When compared to the control group, ALA significantly decreased the postoperative levels of MDA (4.78±0.91 vs. 5.36±1.03 nmol/ml; p= 0.006) CRP (19.44±3.14 vs. 26.56±6.29 mg/dl; p <0.001) and IL-6 (22.25±2.2 vs. 25.37±2.5 pg/ml; p< 0.001) while glutathione level increased significantly in patients who received ALA (26.4±4.59 vs. 23.44±5.11 mg/l; p= 0.005). Conclusion: ALA may help in the prevention of atrial fibrillation following cardiac surgery through exerting antioxidant and anti-inflammatory effects.

scholarly journals Factors for the development of atrial fibrillation after open heart surgery

2021 ◽  
Vol 10 (2) ◽  
pp. 40-44
Author(s):  
D. I. Lebedev ◽  
A. V. Evtushenko ◽  
A. A. Khorlampenko
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Left Atrium ◽  
Heart Valves ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Open Heart Surgery ◽  
Early Postoperative Period ◽  
C Reactive Protein ◽  
Reactive Protein

Aim. To identify the factors influencing the development of postoperative atrial fibrillation (POAF).Methods. The study included 100 patients with indications for cardiac surgery, aged 53 to 82 years (mean age 67.2±17 years). The group included patients who had no history of AF before surgery. Cardiac surgery in the group was presented in 63 patients by coronary artery bypass grafting, and in 37 – by intervention on the heart valves. All respondents were divided into 2 groups: the first included 39 people (39%) who had AF paroxysms lasting more than 30 seconds in the early postoperative period, with a peak at 1–2 days, in 13 (33.3%) cases of AF relapsed. The second group of patients was represented by 61 patients (61%) without cardiac arrhythmias after surgery.Results. The dependence of the development of POAF on age, the concentration of C-reactive protein in the peripheral blood taken on the day of cardiac surgery, the longitudinal size of the left atrium before surgery was revealed.Conclusion. It was found out that a number of factors such as age, preoperative left atrium size, C-reactive protein level in the first days after surgery suggest the development of POAF. The use of the predictors obtained can make it possible to develop an effective strategy for the prevention of POAF. 

Off-Pump Coronary Artery Bypass Surgery May Produce a Hypercoagulable Patient

2005 ◽  
Vol 6 (2) ◽  
pp. 94 ◽  
Author(s):  
Robert L. Quigley ◽  
David W. Fried ◽  
John Pym ◽  
Richard Y. Highbloom
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Open Heart Surgery ◽  
Anticoagulation Therapy ◽  
Maximum Amplitude ◽  
Platelet Activity ◽  
Off Pump ◽  
Pump Coronary Artery Bypass

<P>Background: The incidence of thromboembolic events following traditional open heart surgery has not been clinically significant. However, with beating heart surgery, for which cardiopulmonary bypass (CPB) is not required, the incidence of spontaneous intravascular thrombosis may be similar to that encountered after general surgeries. Compounding this risk is that many cases of off-pump coronary artery bypass (OPCAB) surgery are reserved for the elderly patient with multiple comorbidities. The few studies to date that have assessed the coagulation profile in OPCAB patients have been limited to the first 24 hours after surgery. </P><P>Methods: We prospectively studied 17 OPCAB and 6 on-pump patients over 4 days (hospital course) with daily thromboelastography. A coagulation index (CI) (reflecting R and K times, a angle, and maximum amplitude [MA]) was calculated for the patients, who served as their own controls. </P><P>Results: The OPCAB patients demonstrated 3 days postoperatively a 17% increase in coagulation compared with the baseline. Specifically, the CI consistently revealed an elevation in the a angle and the MA, both of which reflect increased fibrinogen and platelet activity. On the other hand, 3 days following surgery the CI of the CPB group was tightly clustered around their respective baseline CI values, which had recovered from a significant decrease immediately after surgery. </P><P>Conclusion: A state of hypercoagulability, as measured by thromboelastography, exists in the OPCAB patient beyond the first postoperative day, and this finding suggests that prophylactic postoperative anticoagulation therapy targeting fibrinogen and platelet activity may be indicated for these patients.</P>

scholarly journals The Position of Central Venous Catheters Inserted through Arm Veins: A Preliminary Report

1974 ◽  
Vol 2 (1) ◽  
pp. 43-47 ◽  
Author(s):  
D. G. Woods ◽  
Jean Lumley ◽  
W. J. Russell ◽  
R. D. Jack
Keyword(s):  
Preliminary Report ◽  
Heart Surgery ◽  
Venous Pressure ◽  
Venous Blood ◽  
Open Heart Surgery ◽  
Central Venous Catheters ◽  
Open Heart ◽  
Central Venous ◽  
Central Venous Blood ◽  
Catheter Tip

Fifty-three central venous catheters were followed up by radiography or direct observation during open-heart surgery. Forty of these were satisfactorily positioned for recording central venous pressure or for sampling central venous blood. Radiography showed that the catheter tip was in an unsatisfactory position in 21 per cent of cases. It is recommended that radiographic confirmation of the site of the catheter tip be obtained as a routine and if necessary the catheter can be re-positioned and another radiograph taken.

Abstract 266: Incidence, Predictors and Outcomes of Permanent Pacemaker Implantation Among Patients With Bradyarrhythmias Following Cardiac Surgery: Insights From the National Inpatient Sample Database

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Karol Quelal ◽  
Olakanmi Olagoke ◽  
Jose Baez
Keyword(s):  
Cardiac Surgery ◽  
Valve Replacement ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Open Heart Surgery ◽  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
Hospital Death ◽  
National Inpatient Sample ◽  
Permanent Pacemaker Implantation

Introduction: Significant atrioventricular blocks and bradyarrhythmias are known complications of open-heart surgery. These are frequently transient, however, some patients go on to need a permanent pacemaker (PP). We sought to describe the incidence, predictors, and outcomes of PP implantation among patients admitted for cardiac surgery who develop bradyarrhythmias. Methods: We queried the National Inpatient Sample (NIS) database from 2010 to 2014 for adults admitted for surgical valve replacement, valvuloplasty or coronary artery bypass grafting (CABG) who had bradyarrhythmias during the admission using the appropriate ICD codes. We identified patients who had permanent pacemaker implantation documented during the admission. Categorical and continuous variables were compared using the chi-square and student's t-test. Predictors of PP implantation and in-hospital mortality were evaluated by logistic regression. Results: Of the 1402930 patients who underwent cardiac surgery, 94748 patients had bradyarrhythmias defined as sinoatrial node dysfunction (SND) and/or atrioventricular block (AVB) during hospitalization. The primary procedure was identified as valve replacement in 50.3% (47615 of 94748), CABG in 29.9% (27622 of 94748) and valvuloplasty in 8.7% (8248 of 94748). SND was found in 29.9% (28372 of 94748) and AVB in 76% (72017 of 94748). Permanent pacemaker implantation was done in 39.3% (37246 of 94748). Valve replacement was the most common surgery associated with PP implantation [58% (21682 of 37246) compared to 21.5% in CABG (8007 of 37246) and 7.7% in valvuloplasty (2882 of 37246), p < 0.001). Female sex aOR 1.36 (95% CI 1.31 - 1.40), young age 18 - 44 years aOR 1.36 (95% CI 1.24 - 1.49), Asiatic and Hispanic origin aOR 1.36 (95% CI 1.23 - 1.51), aOR 1.25 (95% CI 1.17 - 1.34) respectively, diabetes mellitus with chronic complications aOR 1.16 (95% CI 1.09 - 1.24), drug abuse aOR 1.38 (95% CI 1.21 - 1.55) were associated with higher odds of pacemaker implantation. African American origin aOR 0.79 (95CI 0.74 - 0.85), AIDS aOR 0.33 (95% CI 0.17 - 0.67), south hospital region aOR 0.89 (95% CI 0.85 - 0.93), no-charge admissions aOR 0.66 (95% CI 0.49 - 0.89) were associated with a lower odds of PPM implantation. Death during hospitalization was found in 3% of the patients. After multivariable regression, PP implantation was associated with a lower likelihood of in-hospital death aOR 0.45 (95% CI 0.41 - 0.50). Conclusion: Approximately one-third of the patients hospitalized for cardiac surgery related to AVB and/or SND were implanted a permanent pacemaker. Factors like age, sex, race and comorbidities determine the likelihood of this procedure that has a significant impact on mortality. Having a better insight into these predictors would allow a better triage of patients who would benefit from its implantation.

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