Bivalvular Endocarditis Research Articles

Syphilitic bi-valvular endocarditis and myocarditis: modern tools applied to long-forgotten complications of a re-emerging disease.

The incidence of syphilis has increased steadily over the past 25 years. Undiagnosed cases have presumably increased in the same proportions, and rare complications are at particularly high risk of being unrecognised. A previously healthy 60-year-old man presented with rapidly progressive heart failure and severe aortic and mitral valve insufficiency, with direct valvular destruction and preservation of the aortic valve annulus and aortic root. Treponemal serology was reactive, with rapid plasma reagin titre of 1:128. The patient also had classic manifestations of tertiary syphilis: fusiform aneurysm of the aorta and meningovascular syphilis. He underwent bi-valvular and ascending aorta replacement, and the presence of Treponema pallidum was confirmed by specific immunohistochemistry and PCR in all tissues, including aortic and mitral valves, myocardium, and aorta. This case links T pallidum to infectious endocarditis with severe damage to both aortic and mitral valves, in addition to confirmed syphilitic myocarditis, a long-forgotten complication. It occurred 4 years after probable infection, long before what would be expected according to current understanding of its natural history. Syphilis serology should be considered in patients with culture-negative endocarditis as well as in those with heart failure or arrhythmias of unclear cause, especially in the presence of risk factors for syphilis. Syphilitic endocarditis and myocarditis are potentially lethal but treatable conditions.

Bivalvular Infective Endocarditis with Involvement of the Mitroaortic Fibrosis by Staphylococcus lugdunensis

Bivalvular infective endocarditis is a clinical presentation that is associated to a greater extent with adverse outcomes. The involvement of the intervalvular mitral-aortic fibrosa is a rare complication associated with high mortality rates, requiring high complexity surgery. We report a case of a young male presenting to the emergency department with bivalvular endocarditis and mitral-aortic intervalvular fibrosa involvement.

Characteristics, risk factors and outcomes of patients managed for left-sided infective endocarditis: a prospective study in a high-volume center

Abstract Background Although medical and surgical management of infective endocarditis (IE) have improved in the recent decades, the associated mortality remains high. Available prospective data are scarce, and further knowledge from prospective cohorts could help improving the prognosis of patients with IE. Objective To describe the characteristics and outcomes of left-sided IE and to determine the risk factors associated to in-hospital mortality in a high-volume center. Methods From 15 September 2020 to 15 February 2023, all patients with left-sided IE managed in a tertiary center of cardiology were included in this prospective, observational study. The diagnosis of IE was made according to current guidelines and management was collegially discussed by the endocarditis team. Determinants of in-hospital death were assessed using a multivariate logistic regression model including any covariate associated in univariate analysis (p<0.1). Results A total of 185 patients were included during the study period. Median age was 68 [56 – 76] years, 141 (76%) patients were males, and 75 (41%) cases involved a prosthetic valve. Aortic valve, mitral valve and involvement of both valves were observed in 111 (60%), 48 (26%) and 26 (14%) patients, respectively. Multimodal cardiac imaging, including cardiac computed tomography (CT) and/or PET-FDG, was used in 64 (35%) of all cases, and 49/75 (65%) patients with valvular prosthesis. Severe valvular regurgitation was identified in 56 (30%) patients, root abscess and/or false aneurysms in 57 (31%) patients. A pathogen agent was identified in 169 (91%) patients, and the most frequent germs were Staphylococcus (30%), Streptococcus (30%) and Enterococcus (17%). A severe initial presentation requiring intensive care unit (ICU) admission was observed in 42 (23%) patients. Cardiac surgery was performed in 102 (55%) cases, and 41 (22%) patients required an emergent surgery. A total of 37 (20%) patients died during the initial in-hospital phase, mostly from cardiac or neurovascular causes. In a multivariate analysis, hypertension (Odd ratio (OR) = 3.3; 95% confidence interval (CI): 1.4 – 10), bi-valvular endocarditis (OR = 3.1; 95%CI: 1.0 – 9.5), unidentified pathogen (OR = 4.3; 95%CI: 1.7 – 15) and chronic alcoholic abuse (OR = 16.4; 95%CI: 3.7 – 87.9) were independently associated with increased in-hospital mortality (Table). Conclusion Severe initial presentation requiring an ICU admission and/or urgent cardiac surgery was common among patients with left-sided IE. Chronic alcoholic abuse and unidentified pathogen appear as major determinants of in-hospital mortality.Table

Bi-valvular endocarditis occurring 2 months after COVID-19 infection.

A 60-year-old diabetic man was admitted in cardiology department for dyspnea and fever evolving over 3 weeks with urinary symptoms. In his past history there was a COVID-19 infection that required hospitalization with oxygen therapy for a week and he reported repetitive urinary tract infections. The physical exam showed an axillary temperature at 39.5°c crackling sounds on the lung and no right ventricular failure signs. Laboratory tests showed biologic inflammatory markers elevation; cytobacteriological urine test isolated: enterococcus foecalis and several hemocultures isolated the same named bacteria. Transthoracic echocardiography showed a preserved left ventricular function, a vegetation at the expense of the anterior leaflet of mitral valve (7*4mm); mild mitral valve regurgitation and a huge vegetation at the expense of tricuspid valve (15*20mm) with important tricuspid regurgitation and pulmonary arterial hypertension. The transesophageal echocardiography showed the same vegetation at the expense of the mitral and tricuspid valve and no abnormalities in the other valves. After an initial antibiotic therapy, the patient was referred for surgery in front of worsening mitral insufficiency which has become grade 4.

Bivalvular endocarditis due to Granulicatella adiacens

Patient: Male, 50Final Diagnosis: Bivalvular endocarditis due to Granulicatella adiacensSymptoms: Fever • fatigueMedication: —Clinical Procedure: Echocardiogram • valve replacement surgerySpecialty: Infectious DiseasesObjective:Rare diseaseBackground:Infective endocarditis remains a prominent cause of morbidity and mortality worldwide. It has been estimated that 50% of cases are caused by streptococcal organisms. Abiotrophia and Granulicatella, often grouped as nutritionally variant streptococci (NVS), have become recognized as the cause of nearly 5% of infective endocarditis cases. NVS endocarditis historically has a higher rate of morbidity and mortality, partially due to difficulties in adequately culturing and treating the causative organisms.Case Report:In this report, we review the complicated hospital course and successful treatment of a middle aged Hispanic gentleman who presented with systemic symptoms of fevers, chills and weight loss over 3 months. He was found to have Granulicatella infective endocarditis of the mitral and aortic valves, presumably from a dental source. Despite severe valvular insufficiency noted on echocardiogram, the patient did not initially present with any symptoms of decompensated heart failure. With adequate antibiotic therapy followed by replacement of both valves, the patient had a successful recovery.Conclusions:This case report highlights the growing role that nutritionally variant streptococcus plays in endocarditis and how crucial early identification of the organism is to proper treatment. A brief literature review is also included about the diagnosis and recommended management of nutritionally variant streptococcal endocarditis.

Reconstruction of aorto-mitral continuity with a handmade aorto-mitral bioprosthetic valve for extensive bivalvular endocarditis†

Surgical treatment is effective to exclude all infected tissue in patients with infective endocarditis. Although various techniques have been reported, it has remained a great challenge for patients with extensive infected regions. A patient with extensive bivalvular endocarditis including the aortic and mitral valve and aorto-mitral continuity is described. A handmade aorto-mitral bioprosthetic valve was created to reconstruct the defect after extensive debridement. The patient was discharged on the 30th postoperative day without inflammatory signs.

Culture-negative bivalvular endocarditis with myocardial destruction in a patient with systemic lupus erythematosus: a case report

Culture-negative endocarditis has long been associated with systemic lupus erythematosus, but is usually asymptomatic or involves a single valve. We present a patient with destructive culture-negative endocarditis that remains without a microbial etiology despite an exhaustive workup using advanced diagnostic techniques in a patient with systemic lupus erythematosus.

Clinical and Microbiologic Features of Multivalvular Endocarditis

Multivalvular endocarditis accounts for 15% of all endocarditis. The mechanisms of spread of the infection differs whether endocarditis is only left-sided (involving both the mitral and aortic valves) or bilateral. In left-sided bivalvular endocarditis, it is often a secondary mitral lesion following a primary aortic endocarditis. Multivalvular endocarditis often results in severe and extensive cardiac lesions, well described at echocardiography and frequently responsible for severe heart failure. Patients often need surgery, which consists of radical debridement of all the infected tissue with reconstruction using different types of prostheses; therefore, the surgery may be very complex. The goal should be an early diagnosis of endocarditis to avoid spread of the infection to more than one valve, to improve the prognosis for those patients.

Successful treatment of Candida parapsilosis and Pseudomonas aeruginosa infection using medical and surgical management in an injecting drug user with mitral and aortic valve endocarditis: a case report

IntroductionPolymicrobial endocarditis is a well-recognized problem in intravenous drug users and it accounts for 1 to 3% of endocarditis cases overall and up to 9% in other series. The most common combinations of organisms include Staphylococcus aureus and Streptococcus pneumoniae followed by Staphylococcus aureus and Pseudomonas aeruginosa. Candida parapsilosis endocarditis carries a mortality rate of 45%, and each infection with Candida or Pseudomonas endocarditis per se carries a very high mortality rate approaching 85% and 80%, respectively. The combination of P. aeruginosa and C. parapsilosis has never been encountered and there have been no earlier reports of the combination of C. parapsilosis and P. aeruginosa in adult intravenous drug users as a cause of endocarditis.Case presentationWe present a 49-year-old man with bivalvular endocarditis with P. aeruginosa and C. parapsilosis. He had a prior bivalvular replacement in 2005 that became infected with the above microorganisms and he was treated with intravenous antibiotics. Because of ongoing intravenous drug use, a second valve replacement was denied. A few days later, the patient presented with septic shock secondary to P. aeruginosa and C. parapsilosis recurrent endocarditis. The infection was cured with a second bivalvular replacement and extended therapy with antibiotics and antifungals.ConclusionThis is the first time a patient has presented with P. aeruginosa and C. parapsilosis endocarditis. Relapsing polymicrobial endocarditis can be cured with medical and surgical therapy.

Clinical relevance of vegetation localization by transoesophageal echocardiography in infective endocarditis.

Infective endocarditis is associated with significant morbidity and mortality, with valvular destruction and congestive heart failure being more common in patients with echocardiographically discernible vegetations. The transoesophageal approach affords consistently high quality images with excellent structural resolution. Two-hundred and eighty-one patients with clinically suspected infective endocarditis were studied, to evaluate the prognostic value of ascertaining the site of vegetations. Among them were 118 patients with vegetations attached to the aortic or mitral valve. These patients were followed for a mean period of 14 months. Mitral valve vegetations were associated with a significantly higher incidence of embolic events than vegetations on aortic valves (25% vs 9.7%). The incidence of abscess formation was higher in aortic than in mitral valve endocarditis (6% vs 0%), as were the need for surgical intervention (11% vs 5.5%) and mortality (1.6% vs 0%) respectively). Bivalvular endocarditis was associated with an increased rate of complications: embolism (50%), abscess formation (15%), surgery (35%) and mortality (10%). By multivariate analysis, echocardiographically accessible risk factors for subsequent embolism were a vegetation size of more than 10 mm and mitral valve involvement. Risk factors associated with in-hospital fatality were embolism, a vegetation size of more than 10 mm, and Staphylococcus aureus infection. Our data suggest that the site influences both the rate and the type of complications. Precise echocardiographic visualization of vegetations helps to stratify patients into a high-risk sub-group, perhaps warranting early prophylactic surgical intervention. Transoesophageal echocardiography may play an important role in assessing the clinical outcome for these patients.