Myocardial Abscess Research Articles

EComment. Pseudoaneurysm secondary to native valve endocarditis

We read with great interest the paper by Sartipy et al. regarding the successful surgical management of a left ventricle pseudoaneurysm in a 76-year old patient with mitral valve endocarditis [1]. In this paper, we think that there may be a few matters to be clarified. To date, a handful of reports, mostly isolated case reports and small clinical series, have described successful management of left ventricle pseudoaneurysms [2-4]. What is remarkable in their report is that Sartipy et al. made no allusion in their discussion to a well-known and more frequent aetiology of left ventricle pseudoaneurysm, that is, post-traumatic left ventricular pseudoaneurysm [3]. Penetrating injuries into the heart or blunt thoracic trauma are the second most common cause of left ventricle pseudoaneurysm after extensive myocardial infarction. The possible mechanisms of pseudoaneurysm formation after chest injury include contusion of the myocardial wall, coronary artery injury with secondary myocardial necrosis, and intramyocardial dissecting haematoma. The authors stated that the possible mechanism for pseudoaneurysm formation in their patient was a coronary artery septic embolism. However, this cumbersome complication may also result from a local spread of the infected endocardium to the nearby myocardium. Myocardial abscesses, pseudoaneurysms of the ventricle, and free cardiac ruptures rarely complicate infective endocarditis. Rupture of the myocardial abscess is often fatal, but when the rupture is contained by scar tissue, this entity is known as a post-infective endocarditis pseudoaneurysm. Complete surgical resection with closure of the pseudoaneurysm neck remains the mainstay of therapy, can be curative, but carries a significant risk of mortality and morbidity. In a recently published retrospective study, Dudiy et al. [5] demonstrated that endovascular closure of the left ventricular pseudoaneurysm was a feasible and safe alternative for high-risk surgical candidates and they concluded that individualized management contingent on the anatomic characteristics of pseudoaneurysm and patient comorbidities were paramount. Both the diagnosis and management of pseudoaneurysm of the left ventricle have evolved from more invasive to less invasive strategies, paralleling the advent of sophisticated imaging tools and the development of transcatheter therapies. Conflict of interest: none declared.

Massive Myocardial Abscesses Caused by Methicillin-susceptible <i>Staphylococcus aureus</i>

A 74-year-old woman was admitted to our hospital due to back pain and a low-grade fever lasting for several months. Two years previously, the patient had undergone replacement of a mechanical aortic valve for aortic stenosis. Two weeks later, she suffered from sudden right lower quadrant abdominal pain followed by consciousness disturbance and hypotension. Although a transthoracic echocardiogram showed only mitral valve calcification, blood samples were positive for methicillin-susceptible Staphylococcus aureus, suggesting septic shock, and the patient died two weeks later. Autopsy specimens revealed mitral valve vegetation (Picture A, arrow) with massive perimitral valvular abscesses (Picture A, arrowheads) extending into the adjacent left ventricular myocardium configured as massive myocardial abscesses (Picture B, arrows); however, there was no evidence of infection around the mechanical aortic valve. The organisms most frequently associated with myocardial abscesses are Candida and Staphylococcus aureus (1), and the clinical symptoms may be obscure and not specific as observed in our case (2).

Myocardial abscess secondary to staphylococcal septicemia: Diagnosis with 3D echocardiography

A 56 years old gentleman with staphylococcal septicemia with metastatic abscesses in spleen and heart. Real time 3D trans thoracic echocardiography could not only confirm the diagnosis of myocardial abscess but also well delineate it and identify adjacent structures.

Unusual cardiac outcomes of bacteremia due to Staphylococcus aureus infection: a case report

IntroductionPatients on hemodialysis, particularly those with temporary non-tunneled dialysis access, constitute a high-risk population for bloodstream infections associated with significant morbidity and mortality rates. This population also has a high prevalence of cardiovascular diseases with poor prognosis.Case presentationWe report the case of a 62-year-old Caucasian man with end-stage renal disease undergoing hemodialysis, who presented with an eventually lethal case of staphylococcal septicemia with an unusual involvement of the heart, including bacterial coronary arteritis, myocardial abscesses and papillary muscle infarction and rupture, along with complications involving other organs.ConclusionsIt is important to try to minimize invasive procedures in patients who are hemodialysis dependent. The strict control of heart function is indicated considering the large spectrum of unusual cardiac complications.

Infective Endocarditis in the Pediatric Patient: A 60-Year Single-Institution Review

ObjectiveTo determine the epidemiology of infective endocarditis (IE) presenting in pediatric patients during a 60-year period at our institution. Patients and MethodsIn this retrospective medical record review, we extracted demographic characteristics, diagnostic variables, and outcomes for patients less than 20 years of age diagnosed with IE from January 1, 1980, to June 30, 2011. We compared this cohort with a previously reported cohort of pediatric patients with IE from our institution diagnosed from 1950 to 1979. ResultsWe identified 47 patients (24 males; mean ± SD age at diagnosis, 12.3±5.5 years [range, 1 day to 18.9 years]) who had 53 episodes of IE. The most common isolated organisms were viridans streptococci (17 of 53 episodes [32%]) and Staphylococcus aureus (12 of 53 episodes [23%]). Of the 47 patients, 36 (77%) had congenital heart disease, 24 of whom had cardiac surgery before their first episode of IE (mean ± SD time to IE diagnosis after surgery, 4.2±3.2 years [range, 64 days to 11.3 years]). Fourteen patients (30%) required valve replacement because of valvular IE, and 16 (34%) had complications, including mycotic aneurysm, myocardial abscess, or emboli. Vegetations were identified using echocardiography in 37 of the 53 unique episodes of IE (70%). Endocarditis-related mortality occurred in 1 patient. Compared with the historical (1950-1979) cohort, there were no differences in patient demographic characteristics, history of congenital heart disease, or infecting organisms. One-year mortality was significantly lower in the modern cohort (4%) compared with the historical cohort (38%) (P<.001). ConclusionMost pediatric episodes of IE occur in patients with congenital heart disease. Mortality due to endocarditis has decreased in the modern era.

Perioperative and short-term results of the surgical treatment of infective endocarditis

Infective endocarditis is defined as the infection of the endocardial surface of the heart, which may include one or more heart valves or the mural endocardium. It results in severe valvular insufficiency, which may lead to congestive heart failure, and myocardial abscesses. One of the most feared complications is thromboembolism, through infected emboli. The purpose of this paper is to assess the perioperative and short term results of the IInd Cardiovascular Surgery Department in the treatment of infective endocarditis during a three year period, from January the first, 2002 to September the first, 2005.

Intramyocardial paravalvular abscess after aortic valve replacement

Myocardial abscess is a rare but life-threatening disease with various clinical presentations. We describe the case of a paravalvular abscess distending intramurally 7 years post surgery for aortic valve replacement. Early detection and urgent surgical intervention is essential for this otherwise fatal disease entity.

Viridans streptococcal (Streptococcus mitis) biosynthetic aortic prosthetic valve endocarditis (PVE) complicated by complete heart block and paravalvular abscess

AbstractProsthetic valve endocarditis (PVE) may be classified clinically as early (<60 days) or late (>60 days) post-valve replacement PVE. The pathogens of early versus late PVE differ in type and virulence. Early PVE pathogens are virulent, for example, Pseudomonas aeruginosa and Staphylococcus aureus. Late PVE pathogens resemble those of subacute bacterial endocarditis and are due to relatively avirulent and noninvasive organisms, for example, viridans streptococci. Viridans streptococci vary in their invasiveness and abscess potential. Myocardial abscess and complete heart block are rare complications of late PVE due to viridans streptococci. We present an unusual case of Streptococcus mitis late aortic PVE complicated by aortic root abscess, myocardial abscess, and complete heart block.

Genome Sequence of Listeria monocytogenes 07PF0776, a Cardiotropic Serovar 4b Strain

Listeria monocytogenes is a food-borne bacterial pathogen commonly associated with serious invasive infections of the central nervous system or of the developing fetus. We present the genome sequence of Listeria monocytogenes 07PF0776, a serovar 4b isolate from a human myocardial abscess that exhibits enhanced invasion of cardiac tissue.

EComment. Left ventricle pseudoaneurysm secondary to infective endocarditis

In the interesting case report presented by Singh et al. [1], the patient underwent a successful aneurysmorrhaphy four months after a blunt non-penetrating chest injury. What is remarkable in their report is that the authors make no allusion in their discussion to a previous and well-known aetiology of left ventricle pseudoaneurysm which is infective endocarditis. We [2] and others [3] have published case reports about false aneurysm arising from the left ventricle in patients with infective endocarditis. Myocardial abscess, pseudoaneurysm of the ventricle and cardiac rupture rarely complicate infective endocarditis. Presentation can vary from pericardial effusion to cardiac tamponade occurring in association with annular abscess or myocardial perforation [4]. Formation of a myocardial abscess may be secondary to multiple coronary septic emboli or to local spread from the infected endocardium to the nearby myocardium. Rupture of the myocardial abscess is often fatal, but when the rupture is contained by scar tissue, this entity is known as a post-infective endocarditis pseudoaneurysm. As long as the pseudoaneurysm remains contained, the haemodynamic state will remain good but the chances of survival without surgery remain slim [5]. Conflict of Interest: None declared

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.

Amoebic Liver Abscess: An Appraisal

Amoebic Liver Abscess: An Appraisal

Myocardial abscess as a complication of an infected arteriovenous fistula: autopsy report

Myocardial abscess is a severe and life-threatening infectious complication that is commonly but not exclusively associated with infective endocarditis. It may also be developed in necrotic myocardial tissue, post trauma, in septic burn patients, in transplanted heart, in ventricular aneurysm and post angioplasty. Patients on hemodialysis are prone to bacteremia, and infectious complications occur in 48-73% of cases. Myocardial abscess is a rare complication of an infected arteriovenous fistula. We present an autopsy report of a hemodialysis patient who had an arteriovenous fistula with a polytetrafluoroethylene graft where a local infection developed. The patient presented with fever and toxemia. On post-admission day 2, he unexpectedly suffered sudden cardiopulmonary arrest and died. The autopsy revealed a myocardial abscess, near a branch of the left coronary artery, with septic embolism.

Ruptured Myocardial Abscess Causing Left Ventricle to Pulmonary Artery Communication in an Infant With Community-Associated Methicillin-Resistant Staphylococcus aureus Endocarditis

Myocardial abscess perforation is an extremely rare complication of infective endocarditis. We present a case of a 12-month-old infant who developed community-associated methicillin-resistant Staphylococcus aureus bacteremia after an incision and drainage of a skin abscess. He subsequently developed septic emboli to the brain and lungs, and a myocardial cavity in the outlet portion of the interventricular septum. The cavity ruptured 4 days after diagnosis and created a left ventricle to pulmonary artery fistulous communication. The patient died secondary to embolic complications to the brain. We are not aware of any other cases of myocardial abscess rupture in this location of the heart, in a patient of this age, or due to infection with community-associated methicillin-resistant S aureus .

Left Ventricular Pseudo-pseudoaneurysm with Hemopericardium

We report a case of pseudo-pseudoaneurysm, which is a very rare complication of myocardial infarction. A 69-year-old man was admitted to our clinic with chest tightness and dyspnea. He had undergone aortic valve replacement with a pericardial bioprosthetic valve, ring mitral annuloplasty, and reconstruction of an aortic annular defect due to infective endocarditis with bovine pericardium 4 years prior. Echocardiography and computed tomography showed pericardial effusion and a 16-mm cavity at the anterolateral wall of the left ventricle. Magnetic resonance imaging suggested either pseudo-pseudoaneurysm or myocardial abscess. We successfully repaired the myocardial defect using a patch made from a vascular graft with pledgeted horizontal mattress sutures under cardiopulmonary bypass.

Sterile Abscess in the Myocardium after Direct Intramyocardial Injection Related to Gene Therapy in a Swine Model

Cardiac gene therapy is one of the most promising approaches to cure patients with cardiac dysfunctions. Many ways of efficient gene transfer using viral vectors are tested, and some of them are already used in clinical settings. However, it is always important to be keenly alert to the possible complications when a new therapy is introduced. We present a case of myocardial sterile abscess in a swine model associated with a direct myocardial injection.

Multiple myocardial abscess caused by septicopyemia after blocking therapy in the knee: a rare presentation

Myocardial abscess is considered to be a rare and usually fatal disease, which is often located in the myocardium, endocardium and valves. Myocardial abscess secondary to the infective endocarditis has been well described in literatures. However, it is now relatively uncommon that the myocardial abscess is formed in the setting of septicopyemia. Here, we present a case on multiple myocardial abscesses on the anterior wall of the left ventricle and septicopyemia by Staphylococcus aureus after receiving a blocking therapy in the left knee with an unsterile syringe

Myocardial abscess as a complication of an infected arteriovenous fistula: autopsy report

Myocardial abscess as a complication of an infected arteriovenous fistula: autopsy report

Myocardial abscess: a rare complication of valvular endocarditis demonstrated by 3D contrast echocardiography

Myocardial abscess is a rare and often fatal complication of valvular endocarditis. We present a case of a patient with aortic valve endocarditis whose post-operative course was complicated by a large left ventricular abscess. The spatial location of the defect was difficult to assess with 2D transthoracic echocardiography (TTE); however, real-time 3D contrast TTE allowed us to visualize the full extent of the defect and its precise anatomical location, prior to successful surgical resection.

Pseudoaneurysm of the Left Ventricle in a Young Asymptomatic Female

We report a rare case of a 25-year-old asymptomatic female who was referred for evaluation of a cardiac murmur. She had recent history of treatment for pulmonary tuberculosis. On investigation, she was diagnosed with left ventricular pseudoaneurysm (PSA) likely secondary to rupture of myocardial tubercular abscess. She was operated successfully for the left ventricular PSA and was discharged from the hospital in a good condition.