Aortic Endocarditis Research Articles

Mycotic aneurysm of the left ventricular free wall complicating aortic valve endocarditis

We report the case of a 34-year-old man with aortic valve infective endocarditis caused by methicillin-resistant Staphylococcus aureus, complicated by an aortic annular abscess. A 23-mm St. Jude HP aortic mechanical prosthesis was implanted. The pre-discharge transthoracic echocardiogram revealed a mycotic aneurysm of the basal posteroinferior wall, confirmed by cardiac magnetic resonance imaging, and it was decided to reintervene. The aneurysm was closed with a patch and the mitral valve had to be replaced.Although a small leak from the aneurysm patch persisted on the pre-discharge transesophageal echocardiogram, there was no trace of the aneurysm at nine-month re-evaluation.This case illustrates a rare complication of aortic valve endocarditis and shows the evolution of the mycotic aneurysm after closure via a transmitral approach.

Aneurisma micótico da parede livre do ventrículo esquerdo como complicação de endocardite da válvula aórtica

We report the case of a 34-year-old man with aortic valve infective endocarditis caused by methicillin-resistant Staphylococcus aureus, complicated by an aortic annular abscess. A 23-mm St. Jude HP aortic mechanical prosthesis was implanted. The pre-discharge echocardiogram revealed a mycotic aneurysm of the basal posteroinferior wall, confirmed by cardiac magnetic resonance imaging, and it was decided to reintervene. The aneurysm was closed with a patch and the mitral valve had to be replaced. Although a small leak from the aneurysm patch persisted on the pre-discharge transthoracic echocardiogram, there was no trace of the aneurysm at nine-month re-evaluation. This case illustrates a rare complication of aortic valve endocarditis and shows the evolution of the mycotic aneurysm after closure via a transmitral approach.

Surgical Treatment of Culture-Negative Aortic Infective Endocarditis

We retrospectively analyzed the results of operations done for culture-negative aortic infective endocarditis at a single center over a period of 26 years. From June 1985 to January 2011, we operated on 82 patients with infective endocarditis of the aortic valve for which the results of culture were negative. Sixty-five of the patients (79.3%) were male and the patients' mean age was 38.0±14.4 years (range, 9 to 73 years). Nineteen of the patients (23.2%) had a history of previous cardiac surgery, and 16 of the patients (19.5%) had endocarditis of a prosthetic valve. Two patients (2.4%) had conduction blocks. The mean duration of follow-up was 7.1±4.3 years (range, 0.1 to 16.9 years), yielding a total of 477.0 patient-years for the study population. One hundred and thirty-eight procedures were done on the 82 patients in the study. The most common procedure was aortic valve replacement, which was done on 67 patients (81.7%). Thirty-nine patients (47.6%) had concomitant procedures done on the mitral valve. In-hospital death occurred in 14 patients (17.1%). Postoperatively, 17 patients (20.7%) had a low cardiac output and 9 patients (11.0%) had heart block, of whom 3 required implantation of a permanent pacemaker. The actuarial rate of survival of the patient population at 1, 5, 10, and 15 years was 92.5%±3.2%, 85.6%±4.5%, 82.5±5.3%, and 72.2±10.7% respectively. Culture-negative infective endocarditis is a major problem in the diagnosis and treatment of a significant proportion of cases of endocarditis. Most of the affected patients are in a healed state, which could be a cause of negative culture results. In-hospital mortality in patients with culture-negative infective aortic endocarditis is associated with a history of previous cardiac surgery, whereas long-term mortality in this patient population is associated with nonaortic procedures.

Long-Term Survival of Salvage Cardiac Transplantation for Infective Endocarditis

Cardiac transplantation has been rarely performed in patients with infective endocarditis. A 31-year-old man developed aortic endocarditis due to Brucella melitensis. He presented with fever and developed acute myocardial infarct, severe aortic regurgitation, and heart failure. Aortic valve replacement did not improve cardiac function; hence, an emergent cardiac transplantation was carried out. Eighteen years later, he is doing well and living an active and productive life. Only 6 patients have received a cardiac transplant as part of the treatment of active infective endocarditis. This patient shows how cardiac transplantation may be successfully used as salvage therapy for patients with infective endocarditis who are not candidates for valve replacement or have severe and irreversible myocardial damage.

Reoperation After the Ross Procedure: Incidence, Management, and Survival

The risk of reoperation on the autograft and homograft is the major long-term drawback of the Ross procedure. The incidence and clinical implications of reoperations after the Ross procedure are reported. Between March 1992 and February 2010, 336 consecutive patients had a Ross procedure (mean follow-up, 6.2±4.9 years). Autograft implant technique was freestanding root replacement in 269 patients, subcoronary implantation in 52 patients and a modified root replacement with the autograft included in a Valsalva tube graft in 15. Subsequently, 38 patients (11.3%) underwent reoperations, for autograft dilatation in 23 and a significant autograft insufficiency in 9, at 9.6±3.7 years and 2.6±3.9 years, respectively. Aortic and pulmonary infective endocarditis occurred in 3 patients. Three patients underwent a non valve-related cardiac reoperation. Three patients received a transcatheter pulmonary valve implantation after 12.2±1.7 years. At 15 years, freedoms for autograft and homograft explantation (with 95% confidence interval) were 83.3% (77.4%- to 9.2%) and 92.8% (87.6% to 97.9%), respectively. Native aortic valve regurgitation, indexed aortic annulus diameter exceeding 1.35 cm/m2 and autograft diameter were risk factors for dilated autograft reoperation (hazard ratio, 3.23 [95% confidence interval, 1.19 to 8.81], p=0.02; 3.83 [0.9 to 16.33], p=0.07 and 1.2 per mm [1.01 to 1.41], p=0.03), respectively. Autograft dilatation was the leading cause of reoperation in patients who underwent root replacement. Long-term follow-up is mandatory to determine whether modifications of the operative technique could limit autograft dilatation.

Chest pain with ST segment elevation in a patient with prosthetic aortic valve infective endocarditis: a case report.

IntroductionAcute ST-segment elevation myocardial infarction secondary to atherosclerotic plaque rupture is a common medical emergency. This condition is effectively managed with percutaneous coronary intervention or thrombolysis. We report a rare case of acute myocardial infarction secondary to coronary embolisation of valvular vegetation in a patient with infective endocarditis, and we highlight how the management of this phenomenon may not be the same.Case presentationA 73-year-old British Caucasian man with previous tissue aortic valve replacement was diagnosed with and treated for infective endocarditis of his native mitral valve. His condition deteriorated in hospital and repeat echocardiography revealed migration of vegetation to his aortic valve. Whilst waiting for surgery, our patient developed severe central crushing chest pain with associated anterior ST segment elevation on his electrocardiogram. Our patient had no history or risk factors for ischaemic heart disease. It was likely that coronary embolisation of part of the vegetation had occurred. Thrombolysis or percutaneous coronary intervention treatments were not performed in this setting and a plan was made for urgent surgical intervention. However, our patient deteriorated rapidly and unfortunately died.ConclusionClinicians need to be aware that atherosclerotic plaque rupture is not the only cause of acute myocardial infarction. In the case of septic vegetation embolisation, case report evidence reveals that adopting the current strategies used in the treatment of myocardial infarction can be dangerous. Thrombolysis risks intra-cerebral hemorrhage from mycotic aneurysm rupture. Percutaneous coronary intervention risks coronary mycotic aneurysm formation, stent infections as well as distal septic embolisation. As yet, there remains no defined treatment modality and we feel all cases should be referred to specialist cardiac centers to consider how best to proceed.

Enterococcus cecorum aortic valve endocarditis

We report a case of human aortic valve infective endocarditis caused by Enterococcus cecorum. The organism was recovered from blood and identified by 16S ribosomal gene polymerase chain reaction (PCR). To the best of our knowledge, this is the first documented case of E. cecorum endocarditis. We wish to highlight the use of PCR for organism identification and to describe the initial misidentification of the pathogen.

Granulomatous endocarditis in a patient with Wegener's granulomatosis

Echocardiographic examination of patients with granulomatous endocarditis in patients with Wegener's granulomatosis (WG) reveals vegetation-like lesions that may be misdiagnosed as infective endocarditis resulting in inappropriate therapy. Three-dimensional transesophageal echocardiography aids differential diagnosis. Here, we report the case of a WG patient with associated mitral and aortic granulomatous endocarditis. Although the patient was treated with prednisolone and cyclophosphamide, serial echocardiography did not reveal any significant changes in disease course.

Identification of Bartonella henselae in 2 Cats With Pyogranulomatous Myocarditis and Diaphragmatic Myositis

Most cats infected with Bartonella henselae remain outwardly healthy carriers for years; however, self-limiting fever, transient anemia, neurologic dysfunction, lymphadenopathy, reproductive disorders, aortic valvular endocarditis, and neutrophilic myocarditis have been described in experimentally or naturally infected cats. Two cats in a North Carolina shelter died with pyogranulomatous myocarditis and diaphragmatic myositis. Bacteria were visualized in the lesions by Warthin-Starry silver impregnation and by B. henselae immunohistochemistry. B. henselae DNA was amplified and sequenced from the heart of 1 cat and from multiple tissue samples, including heart and diaphragm, from the second cat. This study supports a potential association between B. henselae and what has been historically described as "transmissible myocarditis and diaphragmitis" of undetermined cause in cats.

Aortic Infective Endocarditis with Paravalvular Abscesses–Freestyle Aortic Root Replacement with Telescoping Proximal Anastomsosis in the Left Ventricular Outflow Tract

Aortic Infective Endocarditis with Paravalvular Abscesses–Freestyle Aortic Root Replacement with Telescoping Proximal Anastomsosis in the Left Ventricular Outflow Tract

Fatal Aortic Endocarditis Associated with Community-Acquired Serratia marcescens Infection in a Dog

A 12 yr old Dalmatian was referred for evaluation of acute lethargy, fever, neurologic signs, and a recently ausculted heart murmur. Echocardiography in combination with blood cultures resulted in a diagnosis of nonhospital-acquired Serratia marcescens bacteremia and aortic valve endocarditis. Despite early diagnosis and aggressive therapy, the dog failed to respond to antimicrobials and died within 6 hr after admission. Necropsy findings included aortic valve endocarditis, septicemia, and diffuse thromboembolic disease. There was no history of pre-existing underlying disease or immunosuppressive therapy, and the dog had not been hospitalized before referral.

Pseudoaneurysm of the Ascending Aorta Combined with Aortic Valve Infective Endocarditis following Cardiac Operations

Aortic pseudoaneurysms are rare but life-threatening complications of aortic procedures. Operation on the femorofemoral bypass with hypothermic circulatory arrest has been the method of choice. Iatrogenic ascending aorta pseudoaneurysm combined with infective endocarditis of the aortic valve has never been reported. We describe a case of a pseudoaneurysm of the ascending aorta at the site of an aortotomy site concomitant with infective endocarditis of the aortic valve. A contrast computed tomographic scan was the investigation technology of choice. The operation was performed on femorofemoral bypass without hypothermic circulatory arrest, which provided safe re-entry and an opportunity to replace the infected aortic valve with a mechanical prosthesis and to repair the aortic defect with a patch. The ascending aorta pseudoaneurysm can be safely operated on with femorofemoral bypass without hypothermic cardiac arrest.

Improved results of surgically treated aortic valve endocarditis using a stentless valve

Objective: Surgical treatment of active aortic endocarditis is still accompanied by a high mortality rate and a high rate of recurrence. We tested our results with a stentless valve, requiring only a single supra-annular suture line for insertion, in a high risk patient group.

Left main artery dissection as a clinical sign of the aortic rupture following aortic valve replacement for fulminant aortic endocarditis

Aortic valve endocarditis with perivalvular abscess formation remains a demanding condition and the results of the surgery are not optimal. Abscess localized in the aortic basis area can weaken the aortic wall, leading to further deterioration and rupture. The presented case allows us to recommend a maximal aggressive approach in patients, in whom the aortic wall seems to be rearranged due to abscess formation. Sometimes only the resection of the abscess hole and replacement of the entire ascending aorta offers a safe therapy option.

Use of Cryopreserved Aortic Homografts as Treatment for Aortic Root Endocarditis at St Vincent's Hospital – 18 Years Follow-up

Use of Cryopreserved Aortic Homografts as Treatment for Aortic Root Endocarditis at St Vincent's Hospital – 18 Years Follow-up

Factors associated with surgery for active endocarditis in congenital heart disease

BackgroundDespite the recent progress of cardiac surgery, the indications for surgical intervention during the active phase of infective endocarditis have not yet been established in patients with congenital heart diseases due to the limited number of such patients. The present study aims to determine the surgical indications for active infective endocarditis in congenital heart diseases. MethodsA retrospective observational cohort multi-center study on infective endocarditis with congenital heart diseases was conducted from January 1997 to December 2001 in Japan and 239 patients were registered. Sixty-one (26%) of the 239 patients had undergone surgical therapy for active infective endocarditis, which was defined as cardiac surgery during administration of intravenous antibiotics. ResultsThere were 7 deaths (11%). A univariate regression analysis revealed that the factors significantly associated with the need for surgical intervention for active IE were the lack of diagnosis of cardiac disorders before the onset of infective endocarditis, aortic valve infective endocarditis, perivalvular abscess, presence of heart failure, and change of antibiotics. A stepwise logistic regression analysis revealed that the presence of a perivalvular abscess, heart failure and a change in the antibiotics were independent determinant factors for the need for surgical treatment of active infective endocarditis in patients with congenital heart diseases. ConclusionsSurgery should therefore be considered even during the active phase in patients with congenital heart diseases and infective endocarditis, when they develop associated with heart failure, a perivalvular abscess, or the need for a change in antibiotics.

Survival and Quality of Life After Aortic Root Replacement With Homografts in Acute Endocarditis

Treatment of prosthetic aortic valve endocarditis and native aortic valve endocarditis with abscess formation is associated with high mortality and morbidity. Aortic root replacement with a freestanding aortic homograft is an attractive alternative. We report outcome and quality of life after homograft replacement for infective endocarditis. Sixty-two patients with infective prosthetic valve endocarditis (n = 31) or native valve endocarditis with abscess (n = 31), operated with homograft replacement were included. Thirty-day mortality, severe operative complications (dialysis, stroke, pacemaker implantation, myocardial infarction, and prolonged mechanical ventilation), midterm survival, reoperations, and quality of life were assessed after a mean follow-up of 37 ± 11 months. Nine patients (15%) died within 30 days and 22 patients (35%) had severe perioperative complications. Preoperative and perioperative variables univariately associated with early mortality were higher (Cleveland Clinic risk score [p = 0.014], extracorporeal circulation time [p = 0.003], prolonged inotropic support [p = 0.03], reoperation for bleeding [p = 0.01], and perioperative myocardial infarction [p < 0.001].) Cumulative survival was 82%, 78%, 75%, and 67% at one, three, five, and ten years, respectively. One patient was reoperated due to recurrence of endocarditis nine months after surgery and one after five years due to homograft failure. Quality of life, as assessed by the 36 item short-form health survey scales for physical and mental health, was not significantly different to an age-matched and gender-matched healthy control group. Severe acute aortic endocarditis treated with homograft replacement is still associated with a substantial early complication rate and mortality. Long-term survival and quality of life are satisfactory in patients surviving the immediate postoperative period.

Endocardite infectieuse aortopulmonaire d’évolution fatale : à propos d’un cas

We report the case of an aortic and pulmonary infective endocarditis in a 25-year-old patient originating from Guinea Conakry. The patient did not have any particular cardiovascular antecedent. He is allowed in a table of total heart failure and fever. The transthoracic echocardiography found vegetations on the level of sigmoid aortic and pulmonary ones. A probabilistic bi-antibiotherapy was instituted while waiting for the results of hemocultures. The patient was apyretic after one week, with regression of inflammatory biological syndrome. However, he was deceased after 20 days in a table of heart failure. The necropsy found vegetations on the level of sigmoid aortic and pulmonary ones, which were perforated, a right lung oedema and a cardiac liver.

Fourier Transform Infrared Microspectroscopy of Endocarditis Vegetation

The objectives of this work were to compare the infrared spectra of bacterial endocarditis vegetation with those of native valvular tissue and the infrared spectra of vegetation bacterial masses with those of surrounding vegetation tissue. Streptococcal aortic endocarditis was induced in three rabbits. Vegetation slices were cryo-sectioned for study by Fourier transform infrared (FT-IR) microspectroscopy. Valvular apparatus, vegetation, and bacterial masses within the vegetation were localized on hematoxylin and eosin (H&E) stained contiguous slices. Infrared images of whole vegetations and images of bacterial masses were acquired with apertures set to 80 x 80 and 20 x 20 microm, respectively. Valvular apparatus and vegetation showed different infrared spectra, mainly in the amide I and amide II bands (1674-1518 cm(-1)), and at about 1450, 1400, 1340, 1280, 1240, 1200, 1080, and 1030 cm(-1). Valvular collagen, elastin, and proteoglycans may explain these differences. Bacterial masses and surrounding vegetation showed different infrared patterns, mainly in the amide I and amide II bands and in the 1142-991 cm(-1) carbohydrate spectral range. Bacterial nucleic acids and polysaccharides may partly explain these differences. Study of experimental endocarditis vegetation using FT-IR microspectroscopy distinguishes (1) the vegetation from the valvular tissue, and (2) the bacterial masses from the surrounding tissue. This study demonstrates for the first time that FT-IR microspectroscopy is able to detect bacterial growth in infected tissue. FT-IR microspectroscopy appears to be a useful tool for investigation of the biochemical structure of endocarditis vegetation.

“Freezing” the left ventricular outflow tract for homograft reconstruction in aortic root endocarditis

“Freezing” the left ventricular outflow tract for homograft reconstruction in aortic root endocarditis