A rare case of anaerobic streptococci endocarditis in a young female with bicuspid aortic valve: case report

Background Bicuspid aortic valve is the most common congenital cardiovascular malformation and occurs in 1–2% of the population. The haemodynamic changes appear early, leading to tissue damage and predisposing to germs attachment. The development of perivalvular extension is a constant in bicuspid aortic valve endocarditis. Infective endocarditis with anaerobic bacteria is a rare condition with a high rate of mortality. Case summary We report a case of a young female with bicuspid aortic valve infective endocarditis. Involved bacteria were anaerobic streptococci, and the clinical course of the diseases was very aggressive. The echocardiographic evaluation revealed aortic and mitral regurgitation, perivalvular abscess, ventricular septum defect, and pericardial effusion. The surgery approach consisted of the aortic valve replacement with a mechanical prosthesis after radical resection of aortic root abscess and reconstruction of the annulus. The ventricular septum defect was also closed with a pericardial patch. Anticoagulation started the first day after surgery. The patient was received antibiotic therapy for 10 days before and 4 weeks after surgical intervention. Evolution was very good at 1 and 6 months follow-up. Discussion This is a severe case of endocarditis, complicated with extensive valvular destruction, aortic root abscess, and fistula. Perivalvular complications are frequent in patients with bicuspid aortic valve endocarditis. The ‘take away’ message is that echocardiography is an essential tool for diagnosis, management, and follow-up of patients with infective endocarditis.

INFECTIOUS ENDOCARDITIS CAUSED BY A RARE AGENT BURKHOLDERIA CEPACIAN

Introduction. Infectious endocarditis (IE) caused by microorganisms Burkholderia cepacia is a very rare and poorly characterized form of endocarditis.Material and methods. We observed a case of late prosthetic mitral valve IE caused by Burkholderia cepacia in a 34-year-old patient.Results. A patient with a congenital ventricular septum defect underwent surgery on the heart three times in past, including the resection of mitral valve vegetations due to IE at age 17 and mitral valve replacement plus ventricular septum defect plastic reconstruction at 33 years old. The last was complicated by postoperative purulent sterno-mediastenitis treated by thoracoplasty. 10 months later the fever with chills appeared again, a large vegetation on a mitral valve prosthesis was revealed, and Burkholderia cepacia bacteremia with multidrug resistance to antibiotics was find. After the start of treatment with trimethoprim / sulfamethoxazole, normal temperature was observed, but the course of IE was complicated by thromboembolism with a fatal outcome.Conclusions. Multidrug resistance of the pathogen to antibiotics, including those empirically prescribed for IE, is the main risk factor for the adverse outcome of IE caused by Burkholderia cepacia. The lack of generally accepted recommendations determining the doses of antibiotics prescribed in accordance with the microorganism sensitivity is the problem still present in Burkholderia cepacia IE treatment.

Unanticipated Ruptured Sinus of Valsalva Aneurysm in a Patient with Subpulmonic Ventricular Septum Defect: Suspected by Intraoperative Transthoracic Echo; Confirmed by Intraoperative Transesophageal Echo

ABSTRACT A sinus of valsalva (SOV) aneurysm is a rare cardiac anomaly that may be congenital or acquired and may be associated with other cardiac lesions. If the aneurysm ruptures, it causes acute symptoms of dyspnea. Echocardiography is a useful diagnostic tool that can guide in proper management of these patients. We present a case of subpulmonic ventricular septal defect (VSD) in which ruptured SOV was detected by intraoperative transthoracic echocardiography and confirmed by transesophageal echocardiography (TEE) which helped in adequate surgical repair and good outcome for the patient. This case report emphasizes the importance of routine transthoracic and TEE in operating room by cardiac anesthesiologist to confirm the original diagnosis and look for new unanticipated findings, especially in a patient with strong clinical suspicion. How to cite this article Bhat IH, Raj R, Puri GD. Unanticipated Ruptured Sinus of Valsalva Aneurysm in a Patient with Subpulmonic Ventricular Septum Defect: Suspected by Intraoperative Transthoracic Echo; Confirmed by Intraoperative Transesophageal Echo. J Perioper Echocardiogr 2015;3(1): 25-28.