Mitral Vegetation Research Articles

Mitral valve repair for infective endocarditis after esophageal reconstruction: a case report

BackgroundIn patients with retrosternal neo-esophageal conduit after right thoracotomy, the approach to cardiac surgery could be challenging. Particularly, in patients with infective endocarditis, there is a risk of injury to the conduit through standard median sternotomy. Moreover, right lung adhesions could be predicted. Herein, we present a case of successful mitral valve repair in a patient with infective endocarditis through a redo right thoracotomy after esophageal reconstruction.Case presentationA 66-year-old male patient was diagnosed with infective endocarditis and a large anterior mitral leaflet vegetation after a previous esophageal reconstruction via right thoracotomy for esophageal cancer. Due to the retrosternal esophageal reconstruction, we performed a mitral valve repair through a redo right thoracotomy. After resecting the vegetation, the defect was closed with a fresh autologous pericardial patch. Mitral valve annuloplasty was performed. Postoperatively, antibiotics controlled the infection. The patient was discharged on postoperative day 30.ConclusionsSuccessful mitral valve repair was performed for infective endocarditis through a redo right thoracotomy after esophageal reconstruction.

Giant progressive mitral vegetation in a case of infective endocarditis caused by Streptococcus agalactiae.

Giant progressive mitral vegetation in a case of infective endocarditis caused by Streptococcus agalactiae.

Mitral Valve Replacement for Enlarged Libman-Sacks Endocarditis in a Patient with Persistent Primary Antiphospholipid Syndrome and Recurrent Stroke: A Case Report.

BACKGROUND Anticardiolipin antibodies in patients with Libman-Sacks endocarditis (LS) are indicative of comorbid antiphospholipid syndrome (APS) and can result in cerebral infarctions. We describe a case of LS and primary APS with recurrent cerebral infarctions despite anticoagulation treatment. The patient underwent surgery for enlarged LS vegetation with high titers of antiphospholipid antibodies. CASE REPORT A 41-year-old Japanese man was admitted to hospital for small cerebral infarction recurrence in a left parietal lesion. At age 35, the patient had suffered multiple cerebral infarctions. He was found to have high serum titers of all 3 antiphospholipid antibodies. Transesophageal echocardiography (TEE) findings were normal. Differential diagnosis ruled out other autoimmune diseases and a clinical diagnosis of primary APS was made. Warfarin anticoagulation was started. When cerebral infarction recurred 6 years after the first episode, serum titers of antiphospholipid antibodies remained high, and TEE showed a 7×8 mm area of mitral vegetation. A TEE results from his first admission revealed a 5×6 mm area of mitral vegetation, which was believed to be related to the current vegetation. As anticoagulation produced no improvement, the mitral valve was replaced with a mechanical valve. Examination of the excised vegetation found it to be consistent with LS. The patient made good progress within 3 years after surgery. CONCLUSIONS LS size can increase despite anticoagulation in cases with high titers of all 3 antiphospholipid antibodies and cerebral infarction. Such patients require ongoing TEE follow-up and surgical treatment should be considered.

Calcified False Tendon Linked to Sudden Cardiac Death in a Young Adult: An Autopsy-based Case Report

Left Ventricular False Tendons (LVFTs) are cord-like structures that traverse the cavity of the left ventricle, connecting the left ventricular free wall or papillary muscle and the ventricular septum without attachment to the mitral valve leaflets. They are incidentally found in autopsy heart specimens. False tendons are generally benign anatomic variants and can be associated with functional murmurs and electrocardiographic abnormalities. False tendons can also be a cause of ventricular arrhythmias. Two-dimensional echocardiography serves as a useful imaging modality in detecting false tendons. They should be differentiated from other entities such as thickened ventricular trabeculations, an accessory anterior mitral leaflet, thrombus, vegetation, and ventricular masses or tumours. Most LVFTs are transverse and are located in the apex. They are found to arise from the inner trabeculated layer of the myocardium. The exact prevalence of LVFTs remains unclear. Present report is a case of postmortem findings in the heart of a 34-year-old male who experienced a sudden collapse while walking after lunch. On gross examination, the left ventricular wall and the lower part of the interventricular septum showed focal grey-white areas. A well-defined, grey-white, hard polypoidal lesion was noted in the left ventricle near the apex, attached to the papillary muscles. The left anterior descending artery showed early atherosclerotic changes. LVFT was diagnosed, which could have been the reason for the arrhythmia. Hence, the evaluation of cardiac murmurs and arrhythmias by two-dimensional echocardiography and cardiac Magnetic Resonance Imaging (MRI) serves as helpful parameters in detecting LVFTs.

Mitral Valve Endocarditis in Patient Awaiting TAVI: A Case Report

The current literature focuses on the risk of infective endocarditis (IE) following transcatheter aortic valve implantation (TAVI). However, the risk of IE in patients waiting for TAVI is not well-studied. We present a unique case of a patient waiting for TAVI with decompensated heart failure who was found to have a large mitral vegetation, and consider risk factors for the development of IE in this population. We report the case of an 85-year-old male with severe aortic stenosis and recurrent small bowel angiodysplasias, requiring frequent blood transfusions and intravenous iron. He presented to a peripheral hospital in decompensated heart failure. Transfer was arranged to our center to expedite TAVI, under the premise that worsening aortic stenosis precipitated his decompensated state. Prior to TAVI, an echocardiogram was done, and demonstrated a 30 × 18 mm mass on the mitral valve with anterior leaflet perforation and severe mitral regurgitation. The findings were consistent with IE, and the TAVI was cancelled. Despite antibiotic therapy, the patient unfortunately deteriorated and palliative care was provided. This case highlights the need for further research regarding the risk of IE in patients waiting for TAVI. Current literature focuses on the development and management of IE following TAVI. Clinicians must understand that TAVI candidates have multiple risk factors for IE, including valvular disease, age, and comorbidities. IE should be considered as a possible cause for decompensated heart failure in patients awaiting TAVI.

Imaging of Cardiac Masses: An Updated Overview.

Studying cardiac masses is one of the most challenging tasks for cardiac imagers. The aim of this review article is to focus on the modern imaging of cardiac masses proceeding through the most frequent ones. Cardiac benign masses such as myxoma, cardiac papillary fibroelastoma, rhabdomyoma, lipoma, and hemangioma are browsed considering the usefulness of most common cardiovascular imaging tools, such as ultrasound techniques, cardiac computed tomography, cardiac magnetic resonance, and in the diagnostic process. In the same way, the most frequent malignant cardiac masses, such as angiosarcoma and metastases, are highlighted. Then, the article browses through nontumoral masses such as cysts, mitral caseous degenerative formations, thrombi, and vegetations, highlighting the differential diagnosis between them. In addition, the article helps in recognizing anatomic normal variants that should not be misdiagnosed as pathological entities.

Vegetation Size, Multiplicity, and Position in Patients With Infective Endocarditis

BackgroundInfective endocarditis is a life-threatening condition and is associated with embolic events. We aimed to evaluate the association of vegetation size, multiplicity, and position with cerebral embolism and late mortality in patients with infective endocarditis. MethodsWe retrospectively reviewed patients with infective endocarditis who were admitted to a single institution between November 2005 and August 2017. A total of 419 patients with infective endocarditis were included in the study, 273 of whom had undergone surgery. The primary endpoint was all-cause mortality, and the secondary endpoint was cerebral embolism. Multivariate Cox regression and logistic regression analyses were performed to identify independent risk factors for 30-day mortality, late mortality, and cerebral embolism. ResultsAge (hazard ratio [HR] 1.02; 95% confidence interval [CI], 1.00 to 1.04), renal failure (HR 4.21; 95% CI, 2.67 to 6.65), surgery (HR 0.31; 95% CI, 0.21 to 0.46), and Acute Physiology and Chronic Health Evaluation II score (HR 1.08; 95% CI, 1.01 to 1.15) were associated with late mortality. Vegetation size, multiplicity, and position were not significantly associated with late mortality, but a mitral vegetation size of greater than 10 mm (odds ratio 2.25; 95% CI, 1.32 to 3.84) was an independent risk factor for cerebral embolism. ConclusionsA vegetation size of greater than 10 mm and the mitral position were found to be significant risk factors for cerebral embolism, and for this group, early surgery might be considered to prevent cerebral embolism.

Abstract 16207: An Uncommon Pathogen Causing Endocarditis and Valve Abscess: Aerococcus Sanguinicola

Introduction: Aerococcus Sanguinicola is a rare pathogen associated with urinary tract infections (UTI). Widespread use of MALDI-TOF can better differentiate Aerococcus species and has led to the identification of A. Sanguinicola as a source of endocarditis. Case Presentation: A 55-year-old male with a history of diabetes mellitus and recent cystitis presented to the hospital with confusion, back pain, fever, chills and myalgias. The patient was tachycardic and hypotensive on exam. Leukocyte count was at 16 k/ul with elevated inflammatory markers. Blood cultures were obtained and empiric vancomycin and cefepime were initiated. Transthoracic echocardiogram revealed mild mitral regurgitation. On hospital day 3, gram stain demonstrated gram positive cocci in clusters, and physical exam revealed a new 3/6 holosystolic murmur in the left 6th intercoastal space. Transesophageal echocardiogram demonstrated acute severe mitral regurgitation and multiple large vegetations with abscess on the anterior leaflet (Figure). Gentamycin was added to treat presumed Staphylococcus Aureus endocarditis. Subsequent species identification revealed A. Sanguinicola as the blood-based pathogen. He underwent bioprosthetic mitral valve replacement due to acute heart failure. Anatomic pathology of the valve confirmed A. Sanguinicola infection. He completed a 6-week course of antibiotics. On his follow up visit at 3 months, the patient had recovered. Conclusion: This case demonstrates a severe case of A. Sanguinicola endocarditis requiring urgent valve replacement. A. Sanguinicola is known to generate biofilms, which are activated by plasma which contrasts with S. Aureus, for which A. Sanguinicola can be mistaken. Additionally, known case of A. Sanguinicola infection demonstrate B-lactams sensitivity. While the organism has the potential to form abscesses, we present the first reported case of valvular abscess that was successfully cured with antibiotics and surgery.

Prevalence and predictors of aortic root abscess among patients with left-sided infective endocarditis: a cross-sectional comparative study

BackgroundAortic root abscess (ARA) is a major complication of infective endocarditis that is associated with increased morbidity and mortality. Limited data are present about patient characteristics and outcomes in this lethal disease. We aimed to study the clinical and echocardiographic characteristics of patients with ARA compared to patients with left-sided infective endocarditis without ARA. We included patients with a definite diagnosis of left-sided infective endocarditis according to modified Duke’s criteria. The patients were classified into two groups according to the presence of ARA (ARA and NO-ARA groups). All the patients were studied regarding their demographic data, clinical characteristics, laboratory and imaging data, and complications.ResultsWe included 285 patients with left-sided infective endocarditis. The incidence of ARA was 21.4% (61 patients). Underlying heart disease, mechanical prosthesis, bicuspid aortic valve, and prior IE were significantly higher in ARA. The level of CRP was higher in ARA (p = 0.03). ARA group showed more aortic valve vegetations (73.8% vs. 37.1%, p < 0.001), more aortic paravalvular leakage (26.7% vs. 4.5%, p < 0.001), and less mitral valve vegetations (21.3% vs. 68.8%, p < 0.001). Logistic regression analysis showed that the odds of ARA increased in the following conditions: aortic paravalvular leak (OR 3.9, 95% CI 1.2–13, p = 0.03), mechanical prosthesis (OR 3.6, 95% CI 1.5–8.7, p = 0.005), aortic valve vegetations (OR 3.0, 95% CI 1.2–8.0, p = 0.02), and undetected organism (OR 2.3, 95% CI 1.1–4.6, p = 0.02), while the odds of ARA decreased with mitral valve vegetations (OR 0.2, 95% CI 0.08–0.5, p = 0.001). We did not find a difference between both groups regarding the incidence of major complications, including in-hospital mortality.ConclusionIn our study, ARA occurred in one fifth of patients with left-sided IE. Patients with mechanical prosthesis, aortic paravalvular leakage, aortic vegetations, and undetected organisms had higher odds of ARA, while patients with mitral vegetations had lower odds of ARA.

A rare presentation of Austrian syndrome with septic arthritis in an immunocompetent female

BackgroundAustrian syndrome, which is also known as Osler’s triad, is a rare aggressive pathology consisting of pneumonia, endocarditis, and meningitis caused by Streptococcus pneumoniae and carries drastic complications.Case presentationA case of a 68-year-old female with a past medical history of hypertension and had a recent viral influenza is presented. She developed bacterial pneumonia, endocarditis with mitral and aortic vegetations and perforation, meningitis, and right sternoclavicular septic arthritis. Two prior case reports have described sternoclavicular septic arthritis as part of Austrian syndrome. Our case is the third case; however, it is the first case to have this tetrad in an immunocompetent patient with no risk factors, i.e., males, chronic alcoholism, immunosuppression, and splenectomy.ConclusionsClinicians should maintain a high index of suspicion for the possibility of sternoclavicular joint septic arthritis as a complication of Austrian syndrome in immunocompetent patients.

Endocarditis infecciosa a Staphylococcus caprae con múltiples embolias preoperatorias graves y vegetación mitral gigante residual

Infective endocarditis is an infrequent disease, heterogeneous presentation, with high mortality, and frequent indication of heart surgery. We introduce the case of a young woman, with S. caprae infective endocarditis, and multiple preoperative serious emboli. Since she presents at admission with infection in progress, splenic abscess and mitral vegetation with high embolic risk, it poses a therapeutic dilemma regarding surgical opportunity and the order in which the complications should be resolved. In this case we proceeded to vascular surgery, then splenectomy and finally valve surgery, all in a short time, to solve the pathology integrally and without complications.

1084. Nocardia Cyriacigeorgica Endocarditis

BackgroundNocardia are beaded, branching Gram-positive rods that are partially acid fast and usually slow growing. Nocardia cyriacigeorgica was first described in 2001, and antimicrobial susceptibility patterns correspond with type VI Nocardia asteroides complex. Nocardia species are not a commonly associated with endocarditis, less than 20 cases to date have been documented. However, when Nocardia endocarditis is identified, the mortality rate is reported to be as high as 41% making antibiotic selection vital in the inpatient and outpatientMethodsA 62-year-old male with a past medical history significant for severe chronic obstructive pulmonary disease (COPD), atrial fibrillation, atrial tachyarrhythmia, and congestive heart failure (CHF) presented to the emergency department (ED) with shortness of breath for 1 week. The patient was initiated on IV diltiazem, meropenem, and eventually required intubation. On hospital day, two blood cultures grew Gram-positive rods, which were eventually identified as aerobic Actinomycete. Culture was sent out for DNA sequencing and N. cyriacigeorgica was identified. Transthoracic echocardiogram showed possible mitral vegetation.ResultsAntimicrobial therapy was initially de-escalated from meropenem to ampicillin, but had to be escalated to ceftriaxone once N. cyriacigeorgica was identified by DNA sequencing. The organism was reported to be susceptible to amikacin, ceftriaxone, linezolid, tobramycin, and trimethoprim/sulfamethoxazole. The patient received 1 week of ceftriaxone therapy inpatient, and was discharged on an additional 3 weeks of ceftriaxone and 6 months of minocycline suppressive therapy.Two months later the patient was re-admitted for N. cyriacigeorgica bacteremia and a pulmonary embolism. During his hospital stay, the patient had a STEMI, but due to multiple comorbidities did not undergo cardiac catheterization. The family elected to withdrawal care, and the patient expired.Conclusion N. cyriacigeorgica is more commonly identified in brain abscesses or skin infections, in the setting of immunosuppression. We report here on an unusual case of N. cyriacigeorgica endocarditis in a patient with COPD. Other than COPD the patient had no known risk factors for N. cyriacigeorgica, including chronic steroid use.Disclosures All authors: No reported disclosures.

Clinical risk factors for acute ischaemic and haemorrhagic stroke in patients with infective endocarditis.

Stroke as a complication of infective endocarditis portends a poor prognosis, yet risk factors for stroke subtypes have not been well defined. To identify risk factors associated with ischaemic and haemorrhagic strokes. A retrospective patient chart review was performed at a single US academic centre to identify risk factors and imaging for patients who were 18 years or older with infectious endocarditis (IE) and stroke diagnoses. Differences in patient characteristics by stroke status were assessed using univariate analysis, χ2 or student's t-test as well as logistic regression models for multivariable analyses and correlation matrices to identify possible collinearity between variables and to obtain odds ratios (OR) and their 95% confidence intervals. A final sample of 1157 participants was used for this analysis. The total number of non-surgical strokes was 178, with a prevalence of 15.4% (78% ischaemic, 10% parenchymal haemorrhages, 8% subarachnoid haemorrhages and 4% mixed ischaemic/haemorrhagic). Multivariate risk factors for ischaemic stroke included prior stroke (OR 2.0, 1.3-3.1), Staphylococcus infection (OR 2.0, 1.3-3.0), mitral vegetations (OR 2.2, 1.4-3.3) and valvular abscess (OR 2.7, 1.7-4.3). Risk factors for haemorrhagic stroke included fungal infection (OR 6.4, 1.2-34.0), male gender (OR 3.5, 1.4-8.3) and rheumatic heart disease (OR 3.3, 1.1-10.4). Among patients with IE, there exist characteristics that relate differentially to ischaemic and haemorrhagic stroke risk.

Intracerebral and Subarachnoid Hemorrhage as a Result of Infective Endocarditis: A Case Report

Infective endocarditis (IE) may have devastating and life-threatening neurological complications. The incidence of intracranial hemorrhage (e.g. subdural hematoma, subarachnoid hemorrhage (SAH), and intracerebral hemorrhage(ICH)) is rare. A 39 years old male, came to emergency unitwith heart failure clinical features, accompanied with fever for 2 weeks, and apical systolic murmur found in the physical examination. In the second day of admission, the patient experienced a sudden decrease of conciousness, weakness of the right limbs, and slurred speech. CT scan examination showed left parietal lobe ICH with volume ± 20 cc, and SAH in left parietal lobe, basalsystern, to pontine systern. Echocardiography revealed AML flail with severe mitral regurgitation and vegetation in AML. Empirical parenteral antibiotics ceftriaxone and gentamicin were given. In the following day, the conciousness was increasing. Later, the blood culture examination showed growing of Staphylococcus saprophyticus.Intracranial hemorrhage may cause worseningin patient’s condition, and require withdrawal in anticoagulant therapy. Cardiac surgery should be delayed.Despite of its uncommon incidence, physician should be aware of the neurological complication of IE to recognize and do the prompt treatment of the disease.

O7-4 - A Case of Left Ventricular Pseudoaneurysm Developed from Myocardial Abscess

The patient was a 57-year-old woman who had undergone maintenance hemodialysis due to diabetic nephropathy. She suddenly developed high fever of 40°C, lumbago and epigastralgia with hypotension and was diagnosed as having septic shock requiring vasopressors and endotoxin adsorption therapy. Laboratory test demonstrated severe inflammation and methicillin sensitive Staphylococcus aureus was cultured from blood samples, but clear source of infection was not detected. After the administration of specific intravenous antibiotics, inflammatory data gradually declined, but 10 days later, she developed high fever and pericarditis. Echocardiogram disclosed pericardial effusion and calcification of the posterior mitral leaflet but vegetation was not detected. Although the aspiration was negative for bacterial growth, we diagnosed her as bacterial pericarditis and continued the administration of antibiotics for four weeks. Thereafter she got well and discharge. One month later, she visited our hospital with anorexia and computed tomography revealed a large pseudoaneurysm of the posterior left ventricular wall just below the posterior mitral valve leaflet. She underwent emergent surgery. The left ventricular aneurysm orifice was closed. If patients on hemodialysis become complicated by long term fever, we need to pay attention to the onset of infective endocarditis.

Abstract WP335: Intracranial Mycotic Aneurysms in Infective Endocarditis: Incidence, Predictors and Outcome

Introduction: Intracranial mycotic aneurysms (IMA) are rare but serious complications of infective endocarditis (IE). Methods and Results: In this retrospective study (1980-2011) we used original Duke criteria to diagnose IE in 1149 episodes (1081 patients; 81% definite, 80% native valve). Neuro complications occurred in 28%, stroke in 22% (202 infarcts, 53 hemorrhages) and 1% had TIA/TMB. N=33 IMA were detected in 23 (2%) patients. IMA were detected in 8% with focal neuro deficits, 13% with seizures, and 3% with encephalopathy. IMA-related symptoms were present in 22 of 23 cases: headache 48%, seizure 13%, altered sensorium 35% and focal deficits 61%. IMA were detected in 0/885 without stroke, 5.4% with infarcts and 22.6% with hemorrhages (p&lt;0.001); the latter included 9/36 (25%) with ICH, 3/13 (23%) with SAH, and 0/4 with SDH. Of the 23 IMA patients 61% had hemorrhage, 30% had SAH and 57% had infarcts. IMAs were detected by DSA in 21/166 (12.7%). The mean size was 3.6±2.4 mm; 30% multiple; 61% located in distal segments; and 67% in MCA branches. On MRI, 31 had any SAH and 45 had any ICH; IMA detected in 6/9 with diffuse SAH, 2/22 with convexal SAH, 11/45 with ICH, and 11/202 with infarcts. Patients with IMA had higher rates of women, hypertension, known cardiac valve disease, mitral regurgitation, mitral vegetation and S.viridians infection (all p&lt;0.05). On multivariable analysis, mitral regurgitation with vegetation (OR 5.9, 95% CI 2.5-14.0, p&lt;0.001) was the only independent predictor of IMA. Clipping was performed in 8 (all pre-2000); endovascular treatment in 7 (all post-1997); 2 died pre- treatment; 1 detected on autopsy; 1 no follow-up available, and 4 regressed/disappeared with antibiotics. Patients with and without IMA showed no difference in rates of in-hospital mortality (22% v. 19%, p=0.93), and length of stay (32d v. 24d, p=0.28). IMA rates did not decrease during the study period (2.2% in 784 episodes 1980-2000 vs. 1.6% of 365 episodes 2001-2011, p=0.653). Conclusion: IMA are invariably heralded by neurological symptoms and stroke (especially hemorrhages) on brain imaging. Mitral IE has the highest risk for IMA. IMAs can resolve with antibiotics however studies are needed to determine the efficacy of different treatment approaches.

Unusually Large Mitral Valve Vegetation Causing Mitral Valve Prolapse and Respiratory Failure

SESSION TITLE: Student/Resident Case Report Poster - Cardiovascular Disease I SESSION TYPE: Student/Resident Case Report Poster PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM INTRODUCTION: Vegetations are characteristic lesions of Infective endocarditis. The size of the vegetation has great clinical significance as it has been shown to determine the probability of complications including embolization, rupture, regurgitation, and heart failure. They contain bacteria and inflammatory cells interspersed in network of platelets and fibrin.In general, lesions greater than 15 mm are considered large vegetations and have higher risk of complications especially if they are mobile CASE PRESENTATION: A 70 year old woman with hyperlipidemia was brought to the hospital with severe respiratory distress. She had intermittent shortness of breath for the last three months which acutely worsened in the week prior to admission. At the time of presentation, she was found to be hypotensive, tachycardic and tachypneic. She had bilateral generalized wheezing. Chest X-ray showed florid pulmonary edema. Troponins were negative and Electrocardiography did not show any ischemic changes. Echocardiography showed an ejection fraction of 75% and severe mitral regurgitation with a 4.5 cm large vegetation in the posterior mitral leaflet that prolapsed into left atrium and left ventricle(Fig-1). Over the past one year, she had frequent dental procedures; last one a week ago. She was intubated for respiratory support and an Intra-Aortic Balloon Pump was placed. Emergency coronary angiography was performed which showed normal coronary arteries. Ceftriaxone, Vancomycin and Gentamicin were started for presumed infective Endocarditis. Blood culture and tissue culture later grew Group B beta hemolytic streptococcus. Subsequently, the mitral valve and vegetation were removed(Fig-2) and she received a bio prosthetic mitral valve implant. Ceftriaxone was continued for a total of 6 weeks with which her condition subsequently improved. DISCUSSION: Vegetations larger than 15 mm are considered large vegetation and they require immediate surgical intervention. Compared to the ones reported in literature, our patient had an enormous vegetation which measured 4.5 cm. It was attached to the posterior mitral leaflet and prolapsed into the left atrium as well as the ventricle along with the blood flow. And, the blood culture grew beta hemolytic Streptococcus. It is unusual given the general understanding that large vegetations tend to be fungal and involve tricuspid valve more than the others. CONCLUSIONS: Size is one of the most important features of infective endocarditis vegetation as it determines the potential risk of complications like embolization, valvular regurgitation and acute heart failure Reference #1: Sanfilippo AJ, Picard MH, Newell JB, et al: Echocardiographic assessment of patients with infectious endocarditis: prediction of risk for complications. J Am Coll Cardiol 1991;18:1191-9 Reference #2: Tischler MD, Vaitkus PT. The ability of vegetation size on echocardiography to predict clinical complications: a meta-analysis. J Am Soc Echocardiogr. 1997 Jun;10(5):562-8 DISCLOSURE: The following authors have nothing to disclose: Karan Wats, Syeda Batul, Suvash Shreshtha, Sunil Abrol, Vijay Shetty No Product/Research Disclosure Information

A Historic Case of Cardiac Surgery in Pregnancy.

Background. Heart disease is the leading cause of nonobstetric mortality in pregnant women. Because of high risk, medical management represents the first line of treatment. However, when medical treatment fails, cardiac surgery becomes necessary. Case Presentation. A 27-year-old female who underwent successfully cardiac surgery three times within 3 years. At the first time, she had an aortic valve replacement at 25 weeks of gestation after an infectious endocarditis complicated with an ischemic stroke. At 39 weeks of gestation, she had delivered, vaginally, a healthy baby boy weighing 2800 g. In the second time, pregnant again at 30 weeks of gestation, she had a mitral valve replacement with an aortic prosthesis reinforcement after a paraprosthetic regurgitation and a mitral vegetation. A fetal death in utero had occurred; the extraction of the fetus by cesarean section with a tubal ligation was performed after stabilization of the mother. In the third time, she underwent successfully a mitral prosthesis replacement with Bentall's procedure after a mitral prosthesis disinsertion with an abscess of aortic annulus due to new episode of infectious endocarditis. Conclusion. Our patient has assembled almost all poor prognosis factors, which makes her a real historic case, probably never described in the literature.

Rapid progression of Staphylococcus lugdunensis mechanical prosthetic valve endocarditis

Abstract A 66-year-old woman with a remote history of mitral valve replacement (mechanical bileaflet valve) due to rheumatic heart disease presented with symptoms consistent with infectious endocarditis. Subsequent blood cultures grew Staphylococcus lugdunensis. A transesophageal echocardiogram demonstrated large vegetations on the atrial aspect of the mitral valve, with a Doppler derived mean pressure gradient of 13 mmHg (Fig. 1 and Video 1). Appropriate i.v. antibiotics were initiated and a surgical consultation was obtained. A second transesophageal echocardiogram was performed 6 days later after she developed acute respiratory failure secondary to pulmonary edema, requiring mechanical ventilation (Video 2). This examination revealed a significant increase in size of the mitral vegetations, with the largest measuring 2.2 cm in maximum dimension, with new complete obstruction of one mechanical leaflet, and with dense spontaneous echo contrast secondary to prosthetic mitral valve obstruction. She subsequently underwent urgent open heart surgery and redo mitral valve replacement with a bioprosthetic valve. Valve obstruction due to large vegetations occurs rarely with infectious endocarditis and is more common with prosthetic (in comparison with native) valves (1, 2, 3). Serial transesophageal echocardiography imaging was helpful in diagnosing this life-threatening complication

Mitral valvular vegetation – As a rare manifestation of granulomatosus polyangitis

Mitral valvular vegetation – As a rare manifestation of granulomatosus polyangitis