Native Mitral Valve Endocarditis Research Articles

Abstract 17883: Subacute Native Aortic and Mitral Valve Endocarditis Manifesting as Embolic ST-Elevation Myocardial Infarction

Case description: A 54-year-old male presented with one day of substernal chest pain. He also reported two months of malaise, myalgias, chills, and intermittent fevers. Medical history was notable for well-controlled hypertension and negative for dyslipidemia, diabetes, or drug and tobacco use. Family history was negative for premature coronary artery disease. Vitals were notable for fever of 103F, blood pressure of 108/56 mmHg, and heart rate of 88 beats per minute. Physical exam showed bounding pulses and a soft diastolic murmur at the left lower sternal border. Electrocardiogram showed inferior lead ST-elevations. He was taken for cardiac catheterization and found to have a totally occlusive thrombus in the distal right coronary artery with minimal disease in the remaining vessels. He underwent aspiration thrombectomy and placement of drug eluting stent with normal flow. He was transferred to the coronary intensive care unit. Labs showed mild leukocytosis, normal serum creatinine, and unremarkable urinalysis. Echocardiogram showed a 1.7 x 0.5 cm mobile echodensity on the aortic valve with severe aortic regurgitation and a small echodensity on the anterior mitral leaflet. Blood cultures grew Enterococcus faecalis. A CT scan of the head, chest, abdomen, and pelvis revealed no embolic disease. He underwent urgent surgery due to concern for infective endocarditis with coronary embolism. Purulence was found at the stent site and the posterior descending artery was obliterated by necrotic tissue. A bypass graft was placed distal to the stent site and infected territory was unroofed and irrigated. Mitral and aortic valve replacement was performed. He tolerated surgery and was discharged with 6 weeks of intravenous antibiotics. Discussion: This case was unique in the subacute chronicity of endocarditis and lack of other systemic emboli. Clinically relevant coronary embolism was reported in only 1.5% of cases of infective endocarditis but microemboli were found in 60% postmortem. Embolization is more common with mitral valve involvement, >10 mm vegetation, and fungal or staphylococcal disease. Angiographic evidence of heavy thrombus burden or lack of significant atherosclerosis after myocardial infarction may prompt evaluation for coronary embolism.

Twenty-Year Experience with Surgery for Native and Prosthetic Mitral Valve Endocarditis.

Background and Objectives: To evaluate the early and long-term results of surgical treatment of isolated mitral native and prosthetic valve infective endocarditis. Materials and Methods: All patients undergoing mitral valve repair or replacement for infective endocarditis at our institution between January 2001 and December 2021 were included in the study. The preoperative and postoperative characteristics and mortality of patients were retrospectively reviewed. Results: A total of 130 patients, 85 males and 45 females, with a median age of 61 ± 14 years, underwent surgery for isolated mitral valve endocarditis during the study period. There were 111 (85%) native and 19 (15%) prosthetic valve endocarditis cases. Fifty-one (39%) patients died during the follow-up, and the overall mean patient survival time was 11.8 ± 0.9 years. The mean survival time was better in patients with mitral native valve endocarditis compared to patients with prosthetic valve endocarditis (12.3 ± 0.9 years vs. 8 ± 1.4 years; p = 0.1), but the difference was not statistically significant. Patients who underwent mitral valve repair had a better survival rate compared to patients who had mitral valve replacement (14.8 ± 1.6 vs. 11.3 ± 1 years; p = 0.06); however, the difference was not statistically significant. Patients who underwent mitral valve replacement with a mechanical prosthesis had a significantly better survival rate compared to patients who received a biological prosthesis (15.6 ± 1.6 vs. 8.2 ± 0.8 years; p < 0.001). Patients aged ≤60 years had significantly better survival compared to patients aged >60 years (17.1 ± 1.1 vs. 8.2 ± 0.9; p < 0.001). Multivariate analysis showed that the patient's age >60 years at the time of surgery was an independent risk factor for mortality, while mitral valve repair was a protective factor. Eight (7%) patients required reintervention. Freedom from reintervention was significantly higher in patients with mitral native valve endocarditis compared to patients with prosthetic valve endocarditis (19.3 ± 0.5 vs. 11.5 ± 1.7 years; p = 0.04). Conclusions: Surgery for mitral valve endocarditis is associated with considerable morbidity and mortality. The patient's age at the time of surgery represents an independent risk factor for mortality. Mitral valve repair should be the preferred choice whenever possible in suitable patients affected by infective endocarditis.

A mouth watering case of Mycoplasma salivarium native mitral valve endocarditis: ‘case report’

BackgroundMycoplasma salivarium is part of our commensal oral flora and readily resides in dental plaque. Although considered indolent, few case reports have documented its pathogenic potential in humans. To this day no case of Mycoplasma salivarium infectious endocarditis has ever been described.Case presentationOur report describes a challenging case of Mycoplasma salivarium endocarditis, with a patient presenting with oligoarticular joint swelling, and later on in the course of his disease developed signs of right-sided heart failure. The diagnosis was initially mistaken for septic gonarthritis and was later established on the basis of echocardiography and eubacterial PCR of joint fluid.ConclusionThis report describes a first documented case of Mycoplasma salivarium culture negative endocarditis that was successfully treated with targeted antimicrobial therapy. Specific antimicrobial therapy targeting Mycoplasma spp, lead to clinical improvement, with radiological regression of the lesion and the resolution of the serum inflammation biomarkers.

Pediculosis As a Possible Contributor to Community-Acquired MRSA Bacteremia and Native Mitral Valve Endocarditis

Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is a known cause of infective endocarditis. In this case report, we describe a patient with community-acquired MRSA bacteremia and subsequent mitral valve endocarditis. This patient was noted to be without commonly recognized risk factors for MRSA bacteremia, thus her likely source was skin colonization, with skin trauma facilitated by pediculosis infestation.

Native mitral valve endocarditis masquerading as ST-segment elevation myocardial infarction

Infective endocarditis (IE) can present with a myriad of clinical syndromes, which make initial clinical diagnosis elusive.[1–3][1] We describe a rare case of native mitral valve IE presenting with multi-territorial myocardial infarction and subsequently complicated by peripheral emboli and

Isolated mitral valve endocarditis: Patient, disease, and surgical factors that influence outcomes

ObjectiveThe objectives of this study were to investigate patient characteristics, valve pathology, bacteriology, and surgical techniques related to outcome of patients who underwent surgery for isolated native (NVE) or prosthetic (PVE) mitral valve endocarditis. MethodsFrom January 2002 to January 2020, 447 isolated mitral endocarditis operations were performed, 326 for NVE and 121 for PVE. Multivariable analysis of time-related outcomes used random forest machine learning. ResultsStaphylococcus aureus was the most common causative organism. Of 326 patients with NVE, 88 (27%) underwent standard mitral valve repair, 43 (13%) extended repair, and 195 (60%) valve replacement. Compared with NVE with standard repair, patients who underwent all other operations were older, had more comorbidities, worse cardiac function, and more invasive disease. Hospital mortality was 3.8% (n = 17); 0 (0%) after standard valve repair, 3 (7.0%) after extended repair, 8 (4.1%) after NVE replacement, and 6 (5.0%) after PVE re-replacement. Survival at 1, 5, and 10 years was 91%, 75%, and 62% after any repair and 86%, 62%, and 44% after replacement, respectively. The most important risk factor for mortality was renal failure. Risk-adjusted outcomes, including survival, were similar in all groups. Unadjusted extended repair outcomes, particularly early, were similar or worse than replacement in terms of reinfection, reintervention, regurgitation, gradient, and survival. ConclusionsA patient- and pathology-tailored approach to surgery for isolated mitral valve endocarditis has low mortality and excellent results. Apparent superiority of standard valve repair is related to patient characteristics and pathology. Renal failure is the most powerful risk factor. In case of extensive destruction, extended repair shows no benefit over replacement.

Mitral valve repair is better than mitral valve replacement in native mitral valve endocarditis: Results from a prospective matched cohort

In native mitral valve infective endocarditis (NMIE), the respective values of mitral valve repair (MVRep) and replacement (MVR) are still debated. To compare MVRep and MVR in a large prospective matched cohort. Between 2010 and 2017, all consecutive patients operated on for NMIE in our centre were included prospectively. Clinical and outcome features were compared between the two groups. Primary endpoint was event-free survival, including death, reoperation and relapse. Univariate and multivariable survival analyses and a propensity score analysis were performed. Among 152 patients, 115 (75.7%) underwent MVRep, and 37 (24.3%) MVR. Median follow-up was 28±22months. Surgery was performed during the active phase in 75.0% of patients (25.7% on an urgent basis). Compared with the MVRep group, patients in the MVR group were more frequently intravenous drug abusers (10.8% vs. 0.9%; P=0.016), had a more frequent history of rheumatic fever (13.5% vs. 0%; P=0.001), more aortic abscesses (16.7% vs. 3.5%; P=0.018), larger vegetations (16.6±8.1mm vs. 12.6±9.9mm; P=0.042) and poorer New York Heart Association status (P=0.006). Overall mortality was lower in the MVRep group than in MVR group (11.3% vs. 29.3%; P=0.018). Event-free survival was better in the MVRep group than in the MVR group in univariate analysis (hazard ratio: 2.72, 95% confidence interval: 1.34-5.52; P=0.004). Survival analysis in the propensity-matched cohort showed that MVRep was safer than MVR (log rank test: P=0.018). Multivariable analysis using the Cox proportional hazard model confirmed this finding (hazard ratio: 3.48, 95% confidence interval: 1.15-10.61; P=0.03). MVRep is feasible in most cases of NMIE and, when technically possible, should be preferred, even in urgent surgery.

Double valve infective endocarditis due to Capnocytophaga canimorsus

Infective endocarditis caused by Capnocytophaga canimorsus, a commensal organism commonly found in dog saliva, is uncommon. We describe a case of a 76-year-old male with native aortic and mitral valve endocarditis with ventricular-atrial fistulization due to Capnocytophaga canimorsus. He was successfully treated with intravenous antimicrobials and surgery. Capnocytophaga canimorsus should be considered as a cause of infective endocarditis in patients with negative blood cultures, in asplenic patients, and in those with appropriate exposures.

Rare case of Proteus mirabilis native mitral valve endocarditis in an immunocompromised patient

BackgroundBacterial infective endocarditis caused by Proteus mirabilis is rare and there are few cases in the literature. The natural history and treatment of this disease is not as clear but presumed to be associated with complicated urinary tract infection (cUTI).Case presentationA 65-year-old female with a history of rheumatoid arthritis, factor V Leiden hypercoagulability, and prior saddle pulmonary embolism presented to the emergency department following a mechanical fall. Computed Tomography showed evidence of acute/subacute splenic emboli. Complicated UTI was likely secondary to a ureteral stone. Blood and urine cultures also grew out P. mirabilis. Transthoracic echocardiography revealed a mobile echogenic density on the anterior mitral valve (MV) leaflet consistent with a vegetation. The patient underwent MV replacement, and P. mirabilis was isolated from the surgically removed valve.ConclusionsWe hypothesize that the patient’s immunocompromised status following steroid and Janus Kinase inhibitor usage for rheumatoid arthritis contributed to Gram-negative bacteremia following P. mirabilis UTI, ultimately seeding the native MV. Additional studies with larger numbers of Proteus endocarditis cases are needed to investigate an association between immunosuppression and Proteus species endocarditis.

A CASE OF NINE WEEKS ON VENO-VENOUS EXTRACORPOREAL MEMBRANE OXYGENATION FOR COVID-19

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: COVID-19 was declared a public health emergency by the World Health Organization in January 2020. The development of acute respiratory distress syndrome (ARDS) due to COVID-19 has high mortality. We present a case of 9 weeks of veno-venous extracorporeal membrane oxygenation (VV ECMO) for COVID-19 ARDS. CASE PRESENTATION: A 47-year-old male with a positive COVID-19 test 5 days prior to admission presented to the emergency department with dyspnea. He was severely hypoxemic prompting admission to the intensive care unit and treatment with high flow nasal canula, glucocorticoids, inhaled nitric oxide and remdesivir. He remained hypoxemic requiring intubation. His hypoxemia worsened despite maximal ventilatory support, proning and paralysis. He was evaluated and considered a candidate for VV ECMO. His cannulation strategy included right femoral vein drainage and right internal jugular (IJ) return cannulas. Anticoagulation for the ECMO circuit was held at 5 days due to bloody secretions and hematochezia. He was started on early nutritional supplementation with high protein tube feeds. Physical therapy included tilting to an upright position with a special bed and passive range of motion exercises. His course was complicated by prolonged respiratory failure requiring tracheostomy, nosocomial pneumonias, bilateral pneumothoraces, right IJ line associated venous thrombosis and bacteremia with native mitral valve endocarditis. At 60 days, his lung compliance began to improve. His ECMO gas sweep and delivered fractional oxygen percentage were incrementally decreased as his native lung gas exchange improved. He was decannulated after 65 days on ECMO. He had continued improvement in physical and respiratory function, including tracheostomy decannulation. He was discharged home after 12 weeks on 1-liter nasal cannula and currently uses oxygen with exertion with minimal dyspnea. DISCUSSION: VV ECMO in traditional ARDS has shown to improve mortality in patients with respiratory failure. Respiratory failure in patients with COVID-19 ARDS tends to be more protracted than traditional ARDS. COVID-19 ARDS patients have higher lung compliance, ventilatory ratio and lung recruitment early in the course. They can have persistent lung diffusion and radiologic abnormalities at 3 months with lingering pulmonary effects post-infection. COVID-19 ARDS patients who require ECMO eventually lose lung compliance. Improvement in tidal volume is the first sign of lung recovery in traditional and COVID-19 ARDS. CONCLUSIONS: VV ECMO is a viable option for the management of COVID-19 ARDS. Longer ECMO support in COVID-19 patients is expected given the difference in lung physiology compared to traditional ARDS and further research into VV ECMO and COVID-19 ARDS is needed. REFERENCE #1: Combes, Alain et al. "ECMO for severe ARDS: systematic review and individual patient data meta-analysis." Intensive care medicine vol. 46,11 (2020): 2048-2057. REFERENCE #2: Haudebourg, Anne-Fleur et al. "Respiratory Mechanics of COVID-19- versus Non-COVID-19-associated Acute Respiratory Distress Syndrome." American journal of respiratory and critical care medicine vol. 202,2 (2020): 287-290. REFERENCE #3: Combes, Alain et al. "Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome." The New England journal of medicine vol. 378,21 (2018): 1965-1975. DISCLOSURES: No relevant relationships by Kathy Chan, source=Web Response No relevant relationships by Hekmat Nasiri, source=Web Response No relevant relationships by Sudhir Rajan, source=Web Response

Native mitral valve endocarditis complicated with abscess and fistulas: Diagnosis by three-dimensional transesophageal echocardiography.

Native mitral valve endocarditis complicated with abscess and fistulas: Diagnosis by three-dimensional transesophageal echocardiography.

The application experience of focused ultrasound heart examination in patients with COVID-19 in Prone-position

Aim of the study. To study the experience of using focused transthoracic echocardiography in patients with COVID-19 in prone position (fEchoPr) in intensive care units (ICU).Materials and methods. The retrospective observational study included 53 patients (period from 15 April to 31 December 2020). Inclusion criteria: confirmed diagnosis of COVID-19, availability of fEchoPr data, outcome certainty (discharge/death). We analyzed electronic medical records. The fEchoPr was performed in patients in the prone position with a bolster under the left side of the chest and left arm raised (‘swimmer’s position’). We assessed the systolic function of the right ventricle (RV) (tricuspid annular plane systolic excursion (TAPSE)), RV size, RV/LV ratio, systolic function of the left ventricle (LV) (left ventricular outflow tract velocity time integral. (LVOT VTI)), and pulmonary hypertension (PH) (tricuspid regurgitation peak gradient (PGTR). Depending on the results, the patients were divided into 2 groups: informative (+fEchoPr) and non-informative (–fEchoPr) examinations.Results. There was no statistically significant difference in the groups (+fEcho n = 35 vs –fEcho n = 18) by age (65.6 ± 15.3 vs 60.2 ± 15.8, p &gt; 0.05), by gender (male: 23 (65.7%) vs 14 (77.8%), p &gt; 0.05), by body mass index (31.3 ± 5.3 kg/m 2 vs 29.5 ± 5.4 kg/m2 , p &gt; 0.05), by mechanical ventilation support (24 (68.6%) vs 17 (94.4%), p = 0.074), by NEWS scale indicators (6.9 ± 3.7 vs 8.5 ± 3.5 points), by mortality (82.8% vs 94.4%, p &gt; 0.05). Correlation analysis revealed a moderate inverse relationship between being on mechanical ventilation and the informative value of the study (Spearman's r = −0.30 at p = 0.033). In the +fEchoPr group, the correct measurement of TAPSE and RV/LV was carried out in 100%: a decrease in RV systolic function was recorded in 5 patients (14%), expansion of the RV in 13 patients (37%). Signs of PH were detected in 11 patients (31%), PGTR could not be measured in 10 patients (28%). LV systolic dysfunction was detected in 7 patients (20%). No pathology was detected in 16 patients (46%). One patient was diagnosed with infective endocarditis of native mitral valve, which was later confirmed by autopsy.Conclusion. In 66% of cases, fEchoPr examinations were informative, especially in terms of assessing the state of the right heart. fEchoPr examination is an affordable, valid and reproducible method to assess and monitor the state of the heart in ICU patients.

Native mitral valve endocarditis complicated with abscess and fistulas: Diagnosis by three-dimensional transesophageal echocardiography

Native mitral valve endocarditis complicated with abscess and fistulas: Diagnosis by three-dimensional transesophageal echocardiography

Minimally invasive surgery versus sternotomy in native mitral valve endocarditis: a matched comparison.

The present study compared the clinical outcomes between minimally invasive surgery (MIS) and median sternotomy (MS) in patients with native mitral valve infective endocarditis. From 2009 to 2019, a total of 154 patients with acute (n = 131, 85%) or subacute (n = 23, 15%) native mitral valve infective endocarditis were included in the study. One-to-one nearest neighbour propensity score matching considering endocarditis severity using the dedicated De Feo score and 19 other clinically relevant baseline variables resulted in a population of 39 matched pairs. The matched cohort was investigated regarding operative and postoperative outcomes. Both groups showed similar results regarding cardiopulmonary bypass time [MIS: 96 min (77-138), MS: 99 min (88-127); P = 0.780] and aortic cross-clamp time [MIS: 64 min (54-90), MS: 65 min (59-83); P = 0.563], whereas overall operative time was shorter through minimally invasive access [MIS: 138 min (112-196), MS: 187 min (175-230); P = 0.005]. Although the rate of revision for bleeding was similar in both groups [MIS: 12.8% (n = 5), MS: 10.3% (n = 4); P = 1.000], MIS was associated with fewer red blood cell unit transfusions [MIS: 1 unit (0-4), MS: 4 units (2-10); P = 0.001] and fewer fresh frozen plasma unit transfusions [MIS: 0 units (0-0), MS: 1 unit (0-5); P = 0.002]. MIS was associated with a shorter ventilation time [MIS: 708 min (429-1236), MS: 1440 min (659-4411); P = 0.024] and a lower rate of reintubation after extubation [MIS: 5.1% (n = 2), MS: 25.6% (n = 10); P = 0.021]. In patients suffering from native mitral valve infective endocarditis, MIS provides significant clinical benefits over sternotomy in selected patients. 117, 121.

Repair of Isolated Native Mitral Valve Endocarditis: A Propensity Matched Study

In the setting of chronic primary mitral regurgitation, the benefit of mitral valve repair over replacement is well established. However, data comparing outcomes for mitral valve surgery for endocarditis is limited. We sought to determine whether mitral valve repair offers traditional advantages over replacement in the endocarditis population. Retrospective review of our institutional mitral valve database (N=8,181) was performed between 1998 and 2019 for all adult patients undergoing isolated mitral valve surgery for endocarditis. Patients were stratified by mitral valve repair or replacement and propensity score matching was performed to adjust for differences in baseline characteristics and degree of valve damage. Overall, 267 surgeries (124 repair, 153 replacement) met inclusion criteria during the study period. Following propensity matching, the repair cohort was associated with shorter initial ventilator times (5.6 vs 7.9 hours, p=0.05), shorter ICU (28 vs 52 hours, p=0.03), and hospital lengths of stays (7 vs 11 days, p < 0.01). Thirty-day mortality (0% vs 2.1%, p=0.01) and 10-year survival (88% vs 86%, p=0.55) were similar between cohorts. Patients in the repair cohort were less likely to require repeat mitral valve intervention at our institution for recurrent endocarditis than those in the replacement cohort (0% vs 10.6%, p=0.03). Mitral valve repair is safe, when feasible, in the setting of isolated native valve endocarditis and may provide patients faster recovery. Experienced mitral surgeons should approach this patient population with a "repair if feasible" methodology.

Mitral valve repair for infective endocarditis: Kobe experience.

ObjectivesWe retrospectively analyzed our experience of mitral valve repair for native mitral valve endocarditis in a single institution.MethodsFrom January 1991 to October 2011, 171 consecutive patients underwent surgery for infective endocarditis. Of these, 147 (86%) had mitral valve repair. At the time of surgery, 98 patients had healed (group A) and 49 had active infective endocarditis (group B). Repair procedures included resection of all infected tissue and thick restricted post-infection tissue, leaflet and annulus reconstruction with treated autologous pericardium, chordal reconstruction with polytetrafluoroethylene sutures, and ring annuloplasty if necessary. Fifty-two (35%) patients required concomitant procedures. The study endpoints were overall survival, freedom from reoperation, and freedom from valve-related events. The median follow-up was 78 months.ResultsThere was one hospital death (hospital mortality 0.7%). Survival at 10 years was 88.5% ± 3.5% with no significant difference between the two groups (p = 0.052). Early reoperation was required in 4 patients in group B due to persistent infection or procedure failure. Freedom from reoperation at 5 years was 99% ± 1.0% in group A and 89.6 ± 4.0% in group B (p = 0.024). Event-free survival at 10 years was 79.3% ± 4.8% (group A: 83.4% ± 5.9%, group B: 72.6% ± 6.9%, p = 0.010).ConclusionsMitral valve repair was highly successful using autologous pericardium, chordal reconstruction, and ring annuloplasty if required. Long-term results were acceptable in terms survival, freedom from reoperation, and event-free survival. Mitral valve repair is recommended for mitral infective endocarditis in most patients.

Native mitral valve endocarditis due to Neisseria elongata following an untreated dental abscess

Native mitral valve endocarditis due to Neisseria elongata following an untreated dental abscess

Reversible Cortical Blindness in Pediatric Native Valve Endocarditis.

Native valve endocarditis, a rare phenomenon in children, can present with septic embolization and devastating consequences. We present a healthy child with bilateral cortical blindness due to native mitral valve endocarditis. After prompt medical and surgical therapy, he regained complete vision. Early surgical intervention resulted in the best outcome.

Prosthetic valve endocarditis: A challenging complication of prosthetic valves.

This study aims to evaluate the surgical outcomes of prosthetic valve endocarditis. A total of 21 patients (6 males, 15 females; mean age 58.9±12.6 years; range, 33 to 79 years) who were surgically treated for prosthetic valve endocarditis between January 2013 and January 2018 were retrospectively analyzed. Surgical indications included persistent fever for more than seven days after antibiotherapy, congestive heart failure refractory to medical treatment, vegetations larger than 1 cm on echocardiography, the presence of fungal endocarditis, severe valvular leak and valvular dysfunction, and staphylococcal prosthetic valve endocarditis. Five patients had previous aortic valve replacement and three of the aortic prostheses were re-replaced. Two patients had coexisting native mitral valve endocarditis and double valve replacement was done. Thirteen patients had previous mitral valve replacement and 12 of the mitral prostheses were re-replaced. One patient had coexisting native aortic valve endocarditis and double valve re-replacement was done. Three patients had previous aortic valve replacement + mitral valve replacement. Mitral valve endocarditis was diagnosed in two patients and these patients had only mitral valve re-replacement. The other patient had double valve endocarditis, and double valve replacement was done. The mean time from the first operation to the development of endocarditis was 7.3±5.7 years. Of five lost patients, two died from multiple organ failure, one from low cardiac output, one from pneumonia, and one from respiratory failure. Radical resection of the infected tissues is critical to achieve favorable surgical outcomes. Single valve replacement of the infected valve may be preferred in patients having previous double valve replacement. Mechanical valves or bioprostheses can be used for re-replacement procedures.

Diagnostic performance of FDG-PET/CTA in native mitral valve endocarditis

Diagnostic performance of FDG-PET/CTA in native mitral valve endocarditis