Infective Endarteritis Research Articles

Infective endarteritis of coronaries following percutaneous coronary intervention (stentocarditis) leading to pseudoaneurysm - a retrospective study of eleven cases.

Coronary endarteritis and stent abscess following percutaneous coronary intervention (PCI) are rare and challenging conditions with no clear treatment guidelines available. This retrospective study aims to present the clinical features, patient and procedural factors, management strategies, and outcomes in 11 consecutive cases referred between 2018 and 2022. We retrospectively analysed 11 cases of coronary endarteritis and stent abscess post-PCI that were referred from various centres. We recorded clinical features, patient demographics, procedural factors, and management approaches, and evaluated treatment outcomes. Among the 11 patients, 7 (63.6%) were male. PCIs had been performed in the right coronary artery (6, 54.5%), left anterior descending artery (3, 27.3%), and circumflex artery (2, 18.2%). The presenting symptoms included fever, pericarditis with effusion, tamponade, and postinterventional angina due to stent occlusion. Fever occurred in 10 (90.9%) patients, and the majority (70%) of patients experienced fever within one week of PCI. Staphylococcus aureus was the predominant organism (54.5%), followed by Pseudomonas aeruginosa. Transthoracic echocardiography revealed abscess cavities in 10 patients. All patients received vancomycin and piperacillin-tazobactam. Surgery was considered in 7 cases with abscesses >2 cm; one patient refused and responded to antibiotics for 4 weeks. Possible risk factors included repeated use of local sites, reuse of hardware, multiple guidewire manipulations, prolonged catheterisation, inadequate sterility, and diabetes. This study provides insights into coronary endarteritis and stent abscess following PCI. The lack of clear treatment guidelines highlights the challenges in managing this condition. Identifying risk factors may aid in preventive strategies. Further research is needed to develop standardised approaches for effective management.

Cover Image

The cover image is based on the Case Report A case of adult patent ductus arteriosus-associated infective endarteritis who was successfully treated with only antibiotics by Akira Kanaiet et al., https://doi.org/10.1002/ccr3.7016.

Utility of Computed Tomography in Diagnosis of a Patent Ductus Arteriosus in Pulmonary Artery Endarteritis

A 15-year-old patient with infective endarteritis had a pulmonary artery vegetation but no ductus arteriosus on echocardiogram. Computed tomography scan revealed a closed ductus that became patent after antibiotics and anticoagulation. Infective endarteritis should be considered in patients with a pulmonary artery vegetation even if no ductus is seen on echocardiogram. (Level of Difficulty: Intermediate.)

Echocardiographic findings in patent ductus arteriosus-associated infective endarteritis.

Infectious endarteritis associated with patent ductus arteriosus (PDA-IE) is an uncommon complication in the era of antibiotics. However, it implies a clinical challenge in patients with a fever of undetermined origin; Two-dimensional transthoracic echocardiography (TTE) performs a fundamental role in diagnosis and follow-up. A retrospective analysis was then made of the data of all patients admitted at our center with PDA-IE within 15 years, and a review of the literature regarding diagnosis, TTE findings, and treatment was performed. A total of 17 patients were identified. The mean age was 17.8 years. The TTE done in all patients confirmed the PDA and PA vegetations diagnosis; in five cases, one vegetation was present; in three cases, two vegetations were found, and in the nine remaining cases, three or more vegetations were observed. In two-thirds of the cases, the vegetations' size was 3 to 28 mm, and the principal morphology was filiform. In all cases, at least one of the vegetations was developed in the DA's lateral wall. Pulmonary valve (PV) was affected in 41% of the patients and caused low to moderate valvular regurgitation. Pulmonary embolism was present in 7 cases and pulmonary aneurism in one case. Decreased incidence of PDA-IE has been currently achieved with early antibiotic therapy. However, today, this complication carries a significant risk of valve damage and other cardiac structures' involvement.

Transcatheter closure of silent patent ductus arteriosus for prevention of endocarditis is justified

A diagnosis of ductal infective endocarditis (DIE) usually relies on the clinical histories of infectious syndrome, results of blood cultures and echocardiography. It remains a therapeutic challenge. The prognosis is still poor. Is the prevention of infective endarteritis a valid reason to always close the isolated silent PDA in childhood? The question is not yet eluded [1] , [2] , [3] , [4] . We present the case of six years old girl with DIE developed after dental procedure. The patient was managed by combined medical and early surgery with favorable evolution. A six year old girl was admitted to our service with tachypnea, fatigue and fever lasting for seven days. The patient had dental procedures few days earlier. The physical examination revealed a temperature at 40 °C and a left subclavian murmur. The acute phase marker levels were significantly elevated and β-hemolytic group A streptococcus was grown in his blood culture. Echocardiography revealed vegetations with the diameter of 10 mm on the left side of the PDA ( Fig. 1 ) with turbulent flow in the left pulmonary artery. Treatment with ceftriaxone 200 mg/kg/day and gentamycin 5 mg/kg/day was started then readapted according to antibiogram. The operation was performed on day 15 of antibiotherapy ( Fig. 2 a and b), whom was continued for 4 weeks. The fever did not return and the clinical course of the patient was stable; the final echocardiogram revealed the absence of left ventricular dilatation with a correct systolic function, normal pulmonary pressure. She was discharged four weeks after the surgical cardiac procedure. Infective endarteritis (IE) complicating PDA is very rare nowadays and the risk is very low especially in the industrialized world. Indeed, standardized management by a skilled multidisciplinary team with expertise in imaging, surgery and intensive care has proven to decrease mortality [3] , [4] , [5] , [6] , [7] . Primary prevention is vital. Even though it was not clear if the closure of a small PDA was beneficial, routine closure of any PDA in children and young adults appeared reasonable. The reasons for this recommendation included the risk of infective endocarditis and low-or-zero morbidity from closure, especially when using a transcatheter device [8] , [9] .

Catheter Closure of Clinically Silent Patent Ductus Arteriosus Using the Amplatzer Duct Occluder II-Additional Size: A Single-Center Experience.

ObjectivesTranscatheter closure is the treatment of choice for most patent ductus arteriosus (PDA) in infants, children, and adults. However, there is a controversy regarding transcatheter closure of clinically silent PDAs. Some authors favor device closure to eliminate the lifelong risk of infective endarteritis while others recommend avoiding PDA closure in such patients. The study describes our experience of closing the silent PDAs using the Amplatzer duct occluder II-additional size (ADO II-AS) (St. Jude Medical Corp, St. Paul, MN).Materials and methodsFrom April 2018 through March 2021, 52 consecutive pediatric patients aged 18 years and less with clinically silent PDA who had transcatheter closure at our center were enrolled. Patients were excluded if they had clinically detected PDAs; had surgical ligation of PDA with no residual shunt; had left heart dilatation on echocardiography; or moderate-sized PDAs closed with ADO II-AS. In addition, patients with an innocent murmur or murmur due to an associated lesion were included. This study was retrospective, and all of the 52 patients underwent PDA device closure using ADO II-AS.ResultsFifty-two consecutive patients were enrolled with a median age of 17 months, range (97-2.5) 94.5 months. Mean weight was 11.29 kilogram, range (24.8-3.5) 21.3 kilogram, and mean follow-up was 13.5 months, range (29-0) 29 months. Thirty-one (59.6%) were females, and 21 (40.4%) were males. The mean procedure time was 30.6 min, range (60-10) 50 min, and mean fluoroscopic time was 5.5 min, range (28-1.7) 26.3 min. The mean volume of contrast given was 9.1 milliliter, range (30-4) 26 milliliter. Forty-five (45; 88.2%) patients had immediate closure of PDA. No patients had anesthetic or vascular complications; however, two patients had procedural complications. Device placement was unsuccessful in one patient with Downs syndrome. The mean follow-up for our patients was 13.5 months, range (29-0) 29 months; the patients were asymptomatic at the follow-up, and none of the patients had any residual leak. None of the patients showed coarctation or left pulmonary artery stenosis at the latest follow-up.ConclusionThe usefulness of catheter-based therapy for silent PDA is less well-established by current evidence. Further studies are needed to justify the intervention solely based on the premise that the silent duct is a substrate for infective endarteritis; however, our reason to close silent PDA was to do so primarily because of social reasons. This study found that device closure of silent PDA is safe and effective using an ADO II-AS device with minimal risk of embolization and a low residual shunt rate. Coils have been used to close small PDAs, however, with higher rates of embolization and device malpositioning. We believe ADO-II AS offers an advantage of safety and efficacy over coils. In addition, the study highlights the advantage of using an ADO II-AS device, which can be delivered via a four French delivery system with no arterial complications.

Acute and intermediate-term outcome of endovascular stenting of native aortic coarctation in adolescents and adult patients

Introduction Coarctation of aorta (CoA) is a common form of cardiac lesions requiring intervention. Recently, endovascular management with stent implantation has emerged as the preferred strategy. We aim to report our single-center experience of stenting in a wide range of patients using different types of stents and later on its complications. Patients and methods Between January 2012 and December 2017, 56 patients who underwent treatment with stents for CoA were retrospectively studied. All the patients underwent echocardiography and computed tomography scans at 6–12 months follow-up. Results There were 18 women and 38 men with a mean age of 23.24±15.75 years (range, 9–55 years). The median sheath size and balloon diameter were 12 mm (10–14 mm) and 14 mm (12–25 mm), respectively. We achieved an immediate success rate of 94.6% with only three cases recording major complications in the form of migration of stent, infective endarteritis, and stent fracture. At 1-year follow-up, no complications were noted in the computed tomography scans. Conclusion Stent implantation is a good choice for the treatment of CoA in adolescents and adults. It is associated with a low-residual gradient and a low rate of restenosis, both immediately and at mid-term follow-up. It has a relatively low incidence of complications.

Ascending Aorta and Total Aortic Arch Replacement in a Child with Infective Endarteritis

Ascending Aorta and Total Aortic Arch Replacement in a Child with Infective Endarteritis

A Case of Infective Pulmonary Endarteritis in a Young Male

A Case of Infective Pulmonary Endarteritis in a Young Male

Anesthetic management of patent ductus arteriosus in adults

Patent ductus arteriosus (PDA) is an extracardiac left to right shunt. It should be corrected at an early age, but some patients may survive into adult life even without repair. Anesthetic management for adult patients with PDA poses many challenges for the anesthesiologist due to alterations in the cardiopulmonary physiology. We report successful anesthesia management of a case of an adult patient of PDA with moderate pulmonary artery hypertension with infective endarteritis (two large mobile vegetations at the pulmonary end of the duct).

Paraplegia in spinal tuberculosis due to anterior spinal artery syndrome

Tuberculosis remains a major public health problem especially in developing countries. Around 10% of patients with extra pulmonary tuberculosis may have bone and joint involvement and half of them will have tuberculosis of spine. Paraplegia is the most dreaded complication of spinal tuberculosis. Infective thrombosis or endarteritis of spinal vessels leading to infarction of the spinal cord is a very rare cause of paraplegia. We describe a 45-year-old lady presenting with spinal tuberculosis leading to paraplegia with associated anterior spinal arterial thrombosis.

Infective Endarteritis in a Patent Ductus Arteriosus

The ductus arteriosus, an essential fetal structure, normally closes spontaneously soon after birth. It’s persistence into late adulthood is considered rare; infective endarteritis complicating a patent ductus arteriosus (PDA) is an even rarer event. The clinical picture of an infected PDA could be subtle, and the diagnosis is frequently delayed. Symptoms may well be attributed to community acquired pneumonia, pleurisy, or pulmonary infarction from pulmonary embolism. Occasionally, especially in the case of silent PDA, the correct diagnosis can be reached after an extensive work up of fever of unknown origin.

A case of pulmonary infective endarteritis associated with patent ductus arteriosus: surgical closure under circulatory arrest

A 35-year-old man was admitted to the hospital with prolonged high-grade fever. Chest computed tomography revealed multiple pulmonary infiltrations in both lungs, suggesting septic emboli. Echocardiography revealed patent ductus arteriosus and mobile large vegetations in the pulmonary artery. Because of uncontrollable infection and the imminent possibility of massive pulmonary embolism, he underwent transpulmonary surgical closure of the ductus and resection of the vegetations under hypothermic circulatory arrest using cardiopulmonary bypass. We report a rare case of open heart surgery in a patient with pulmonary infective endarteritis associated with patent ductus arteriosus.

Neonatal infective endarteritis complicating patent ductus arteriosus

Infective endarteritis complicating patent ductus arteriosus (PDA) is a rare occurrence. Most cases are reported in older children and adults, and there are little published data describing this condition in the preterm neonate. We outline the presentation, clinical course, management and outcome of two affected infants born at less than 27 weeks of gestation. This report highlights the importance of a detailed cardiac evaluation in a neonate with persisting bacteraemia. An increasing awareness of neonatal ductal endarteritis combined with the wider availability of more sensitive echocardiography has implications for local neonatal service delivery.

Pulmonary Artery Aneurysm in a Child Secondary to Infective Endarteritis

A 5-year-old boy with main pulmonary artery aneurysm is described with two predisposing factors of patent ductus arteriosus and associated infective endarteritis. Transthorasic echocardiography showed definitely a saccular aneurysm originating from the main pulmonary artery at the site of a previous vegetation. Antibiotic therapy and surgical resection of the aneurysm allowed for clinical improvement.

Analysis of infective endarteritis in patent ductus arteriosus

This study reports on infective endarteritis in 14 children with patent ductus arteriosus over a period of 6 years. Infective endarteritis mostly involved the small ducts and was previously undiagnosed. These patients were given antibiotic treatment for a variable period of 4 to 10 weeks, and all except 1 underwent subsequent closure.

Nonvalvular cardiovascular device-related infections.

More than a century ago, Osler took numerous syndrome descriptions of cardiac valvular infection that were incomplete and confusing and categorized them into the cardiovascular infections known as infective endocarditis. Because he was both a clinician and a pathologist, he was able to provide a meaningful outline of this complex disease. Technical advances have allowed us to better subcategorize infective endocarditis on the basis of microbiological etiology. More recently, the syndromes of infective endocarditis and endarteritis have been expanded to include infections involving a variety of cardiovascular prostheses and devices that are used to replace or assist damaged or dysfunctional tissues (Table 1). Taken together, infections of these novel intracardiac, arterial, and venous devices are frequently seen in medical centers throughout the developed world. In response, the American Heart Association’s Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease wrote this review to assist and educate clinicians who care for an increasing number of patients with nonvalvular cardiovascular device–related infections. Because timely guidelines1,2 exist that address the prevention and management of intravascular catheter–related infections, these device-related infections are not discussed in the present Statement. View this table: TABLE 1. Nonvalvular Cardiovascular Device–Related Infections This review is divided into two broad sections. The first section examines general principles for the evaluation and management of infection that apply to all nonvalvular cardiovascular devices. Despite the marked variability in composition, structure, function, and frequency of infection among the various types of nonvalvular cardiovascular devices reviewed in this article, there are several areas of commonality for infection of these devices. These include clinical manifestations, microbiology, pathogenesis, diagnosis, treatment, and prevention. The second section addresses each device and describes unique clinical features of infection. Each device is placed into one of 3 categories—intracardiac, arterial, or venous—for discussion. ### Clinical Manifestations The specific signs and symptoms associated with an infection of a …

126 Aortic complications of coarctation of aorta in adults: aneurysm, pseudoaneurysm, infective endarteritis, dissection, fistulae and aortic rupture

126 Aortic complications of coarctation of aorta in adults: aneurysm, pseudoaneurysm, infective endarteritis, dissection, fistulae and aortic rupture

Persistent ductus arteriosus in the adult: clinical features and experience with percutaneous closure

Persistent ductus arteriosus in the adult carries a risk for becoming symptomatic with dyspnoea or palpitations, developing infective endarteritis, and finally for developing pulmonary hypertension with ensuing heart failure morbidity and mortality. Surgical closure is considered more and more to be outdated as first choice treatment since percutaneous closure is a safe and effective alternative. Only the Eisenmenger syndrome remains a clear contra-indication for closure, whether surgical or interventional.We report on our own experience in nine patients with persistent ductus arteriosus including eight cases who underwent percutaneous closure and one patient with Eisenmenger syndrome. In addition, our experience with clinical features and therapeutic modalities is related to the literature.

Incidence of infective endarteritis in adults with a patent ductus arteriosus

Incidence of infective endarteritis in adults with a patent ductus arteriosus