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Tahara M, Nagai T, Takase Y, Takiguchi S, Tanaka Y, Kunihara T, Arakawa J, Nakaya K, Hamabe A, Gatate Y, Kujiraoka T, Tabata H, Katsushika S. Primary Mural Endocarditis Without Valvular Involvement. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:659-664. [PMID: 28127793 DOI: 10.7863/ultra.16.03049] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 06/03/2016] [Indexed: 06/06/2023]
Abstract
Primary mural endocarditis is an extremely rare infection in which nonvalvular endocardial involvement is seen without any cardiac structural abnormalities such as ventricular septal defects. The rapid and precise diagnosis of this disease remains challenging. We present 2 cases (67- and 47-year-old male patients) of pathologically confirmed primary mural endocarditis that could have been detected by initial transthoracic echocardiography in the emergency department. Transthoracic echocardiography and transesophageal echocardiography play critical roles in the early recognition and confirmation of primary mural endocarditis.
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Affiliation(s)
- Mai Tahara
- Department of Cardiology, Japan Self Defense Forces Central Hospital, Tokyo, Japan
| | - Tomoo Nagai
- Department of Cardiology, Japan Self Defense Forces Central Hospital, Tokyo, Japan
| | - Yoshiyuki Takase
- Department of Cardiology, Japan Self Defense Forces Central Hospital, Tokyo, Japan
| | | | - Yoshiaki Tanaka
- Department of Cardiovascular Surgery, Saitama-Eastern Cardiovascular Hospital, Koshigaya, Japan
| | - Takashi Kunihara
- Department of Cardiovascular Surgery, Cardiovascular Institute Hospital, Tokyo, Japan
| | - Junko Arakawa
- Department of Cardiology, Japan Self Defense Forces Central Hospital, Tokyo, Japan
| | - Kazuhiro Nakaya
- Department of Cardiology, Japan Self Defense Forces Central Hospital, Tokyo, Japan
| | - Akira Hamabe
- Department of Cardiology, Japan Self Defense Forces Central Hospital, Tokyo, Japan
| | - Youdou Gatate
- Department of Cardiology, KKR Mishuku Hospital, Tokyo, Japan
| | | | | | - Shuichi Katsushika
- Department of Cardiology, Japan Self Defense Forces Central Hospital, Tokyo, Japan
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2
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Staphylococcal endocarditis presented with left ventricular cysts and right atrial mass in a drug abuser. Int J Cardiol 2008; 128:e40-2. [PMID: 17949837 DOI: 10.1016/j.ijcard.2007.05.071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2007] [Accepted: 05/26/2007] [Indexed: 11/20/2022]
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3
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Ivens EL, Moss RR, Thompson CR, Munt BI. Multisite Infective Endocarditis with Widespread Pulmonary and Systemic Embolization in the Setting of Overwhelming Staphylococcal Sepsis. J Am Soc Echocardiogr 2007; 20:1318.e1-4. [PMID: 17588721 DOI: 10.1016/j.echo.2007.03.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2007] [Indexed: 11/26/2022]
Abstract
The presence of simultaneous left- and right-sided endocarditis affecting the cardiac structures is rare and information regarding clinical presentation, pathophysiologic mechanisms, and prognosis is limited. We report the case of a young woman who presented to our institution with severe staphylococcal peritonitis and generalized sepsis who had tricuspid valve and left ventricular (LV) mural endocarditis. Significant transpulmonary shunting was demonstrated using transesophageal imaging and saline contrast injection. In this case transesophageal echocardiography (TEE) provided enhanced imaging of an unusual form of right- and left-sided endocarditis. More importantly, the use of TEE and saline contrast injection suggested an interesting hypothesis that might ultimately contribute to an improved understanding of pathophysiologic mechanisms in infective endocarditis and severe sepsis.
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Bitigen A, Bayrak F, Tigen K, Mutlu B. Large Mural Vegetation Attached to the Left Ventricular Outflow Tract: A Case Report. Heart Surg Forum 2007; 10:E1-2. [PMID: 17162391 DOI: 10.1532/hsf98.20061120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We describe an unusual case of staphylococcal endocarditis with vegetation attached to the left ventricular outflow endocardium in a patient with chronic severe aortic regurgitation that was diagnosed by transthoracic echocardiography. There was no involvement of aortic valve endocardium confirmed by transthoracic echocardiography, transesophageal echocardiography, and macroscopically in the operation. This report confirms that chronic endocardial trauma may provide a fertile nidus for the development of bacterial vegetation.
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Affiliation(s)
- Atila Bitigen
- Kosuyolu Heart and Research Hospital, Istanbul, Turkey
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5
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López-Ciudad V, Castro-Orjales MJ, León C, Sanz-Rodríguez C, de la Torre-Fernández MJ, de Juan-Romero MAP, Collell-Llach MD, Díaz-López MD. Successful treatment of Candida parapsilosis mural endocarditis with combined caspofungin and voriconazole. BMC Infect Dis 2006; 6:73. [PMID: 16608509 PMCID: PMC1458348 DOI: 10.1186/1471-2334-6-73] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2005] [Accepted: 04/11/2006] [Indexed: 11/23/2022] Open
Abstract
Background Fungal mural endocarditis is a rare entity in which the antemortem diagnosis is seldom made. Seven cases of mural endocarditis caused by Candida spp. have been collected from literature and six of these patients died after treatment with amphotericin B. Case presentation We report a case of mural endocarditis diagnosed by transesophageal echocardiogram and positive blood cultures to Candida parapsilosis. Because blood cultures continued to yield C. parapsilosis despite caspofungin monotherapy, treatment with voriconazole was added. Conclusion This is the first description of successful treatment of C. parapsilosis mural endocarditis with caspofungin and voriconazole.
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Affiliation(s)
- Víctor López-Ciudad
- Intensive Care Unit, Hospital Santa María Madre-Complejo Hospitalario de Ourense, Ourense, Spain
| | - María J Castro-Orjales
- Intensive Care Unit, Hospital Santa María Madre-Complejo Hospitalario de Ourense, Ourense, Spain
| | - Cristóbal León
- Intensive Care Unit and Emergency Service, Hospital Universitario de Valme, Sevilla, Spain
| | - César Sanz-Rodríguez
- Department of Clinical Research, Merck Sharp & Dohme de España, S.A. Madrid, Spain
| | | | | | - María D Collell-Llach
- Department of Cardiology, Hospital Santa María Madre-Complejo Hospitalario de Ourense, Ourense, Spain
| | - María D Díaz-López
- Unit of Infectious Diseases, Hospital Santa María Madre-Complejo Hospitalario de Ourense, Ourense, Spain
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Caruso A, Iarussi D, Dialetto G, Covino F, Crispo C, Coppolino P, Tripoldi MF, Utili R. Unusual cases of infective endocarditis. J Am Soc Echocardiogr 2002; 15:93-5. [PMID: 11781562 DOI: 10.1067/mje.2002.116311] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We report 2 patients with unusual cases of infective endocarditis. The first patient had a large, mural vegetation on left ventricle that was diagnosed with transthoracic echocardiography; and the second patient had a large, mobile vegetation in the descending prosthetic aorta with an abscess cavity around the vessel, diagnosed by transesophageal echocardiography. This report confirms the usefulness of transthoracic and transesophageal echocardiography in the diagnosis and management of uncommon cases of endocarditis.
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Affiliation(s)
- Aurelio Caruso
- Dipartimento di Scienze Cardio-Chirurgiche, Toraciche e Respiratorie, Ospedale Monaldi, Naples, Italy
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Krivokapich J, Child JS. Role of transthoracic and transesophageal echocardiography in diagnosis and management of infective endocarditis. Cardiol Clin 1996; 14:363-82. [PMID: 8853131 DOI: 10.1016/s0733-8651(05)70290-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Echocardiography has become a mainstay in the diagnosis of endocarditis. Vegetations were first visualized noninvasively beginning with M-mode echocardiography in the mid-1970s. The evolution of echocardiography, to include first two-dimensional imaging and then Doppler imaging in the 1980s, established echocardiography as the noninvasive test of choice to evaluate for the presence of vegetations as well as for their sequelae. Most recently, the addition of transesophageal echocardiography has expanded the role and yield of echocardiography in diagnosing endocarditis as well as in guiding management.
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Affiliation(s)
- J Krivokapich
- Department of Medicine, University of California Los Angeles School of Medicine, USA
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8
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Mügge A, Daniel WG. Echocardiographic assessment of vegetations in patients with infective endocarditis: prognostic implications. Echocardiography 1995; 12:651-61. [PMID: 10158102 DOI: 10.1111/j.1540-8175.1995.tb00858.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Today, echocardiography is the most important technique next to clinical findings and blood cultures in the diagnosis of infective endocarditis. The sensitivity of echocardiography, particularly the transesophageal approach, for detection of vegetations and endocarditis related valvular destructions is high. In addition, echocardiographic findings may have some prognostic implications. The size and mobility of vegetations stratifies endocarditis patients into a high risk group for arterial embolism. In particular, mobile vegetations attached to the mitral valve with a maximal diameter > 10 mm may be prone to embolic events. Furthermore, increase in size of vegetations during antimicrobial treatment may identify patients with no, or at least a prolonged, healing process. Also, a lack of increase in the echo density of vegetations under adequate antibiotic treatment may indicate a poor healing process and may necessitate more aggressive management. The demonstration of paravalvular abscesses by echocardiography, particularly by transesophageal echocardiography, identifies a subgroup of patients who will need urgent cardiac surgery before widespread tissue destruction has occurred.
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Affiliation(s)
- A Mügge
- Department of Internal Medicine, Hannover Medical School, Germany
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Gabrielli F, Alcini E, Di Prima MA, Mazzacurati G, Masala C. Cardiac valve involvement in systemic lupus erythematosus and primary antiphospholipid syndrome: lack of correlation with antiphospholipid antibodies. Int J Cardiol 1995; 51:117-26. [PMID: 8522406 DOI: 10.1016/0167-5273(95)02357-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The aim of this study was to determine the prevalence of cardiac valve disease in systemic lupus erythematosus or in patients with primary antiphospholipid syndrome and to assess the role of the antiphospholipid antibodies as risk factor for endocardial lesions. We studied 39 consecutive patients with systemic lupus erythematosus (mean age 34 +/- 12 years, 38 female and one male), 20 women with primary antiphospholipid syndrome (mean age 32 +/- 4 years) and 20 normal subjects (mean age 35 +/- 8 years, 15 female and five male). All patients with primary antiphospholipid syndrome had increased levels of serum anticardiolipin antibodies and recurrent fetal abortions; some of them also had arterial and/or venous thrombosis and/or thrombocytopenia. M-mode, two-dimensional and Doppler echocardiography were performed in all patients. IgG anticardiolipin antibodies were measured by an enzyme-linked immunosorbent assay. Valvular lesions were observed in 15 patients (38%) with systemic lupus erythematosus. These abnormalities included: mitral valve thickening or vegetation, mitral valve prolapse and aortic valve vegetation; mitral, aortic and tricuspid regurgitation; mitral stenosis. None of the patients with primary antiphospholipid syndrome and of the normal subjects was found to have valvular abnormalities. In systemic lupus erythematosus, high levels of anticardiolipin antibodies were detected in 73% of the patients with valvular lesions and in 67% of the patients without valvular lesions (P > 0.05). We conclude that valvular involvement is frequent in patients with systemic lupus erythematosus but it is apparently unrelated to antiphospholipid autoimmunization.
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Affiliation(s)
- F Gabrielli
- Department of Cardiovascular and Respiratory Sciences, University La Sapienza, Rome, Italy
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Shirani J, Keffler K, Gerszten E, Gbur CS, Arrowood JA. Primary left ventricular mural endocarditis diagnosed by transesophageal echocardiography. J Am Soc Echocardiogr 1995; 8:554-6. [PMID: 7546795 DOI: 10.1016/s0894-7317(05)80346-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Primary left ventricular mural abscess was detected by transesophageal echocardiography and was confirmed at necropsy in a 44-year-old woman with Staphylococcus aureus bacteremia and cerebrovascular embolism. In two occasions, transthoracic echocardiography failed to show the mural abscess in this patient. Because of the aggressive nature of primary mural endocarditis, early use of transesophageal echocardiography is recommended in patients with Staphylococcal bacteremia and suspected endocarditis even in the absence of valvular abnormalities detectable by the transthoracic approach.
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Affiliation(s)
- J Shirani
- Department of Medicine, Medical College of Virginia, Richmond, USA
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Mügge A. ECHOCARDIOGRAPHIC DETECTION OF CARDIAC VALVE VEGETATIONS AND PROGNOSTIC IMPLICATIONS. Infect Dis Clin North Am 1993. [DOI: 10.1016/s0891-5520(20)30564-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Burger AJ, Peart B, Jabi H, Touchon RC. The role of two-dimensional echocardiology in the diagnosis of infective endocarditis [corrected]. Angiology 1991; 42:552-60. [PMID: 1863015 DOI: 10.1177/000331979104200706] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Two-dimensional echocardiography has had a significant impact on and is considered the technique of choice for the diagnosis and management of infective endocarditis. Over a thirty-six month period, 106 patients were evaluated by echocardiography for the possibility of endocarditis. The diagnosis of endocarditis was determined by strict clinical and laboratory criteria. All clinical histories, blood cultures, echocardiograms, and autopsy results were reviewed. Five echocardiograms were technically inadequate, resulting in a study population of 101 patients. The age of the patients ranged from forty-five days to eighty-eight years (mean fifty-seven years). The clinical manifestations of endocarditis included fever (83%), chills (60%), congestive heart failure (25%), and splenomegaly (18%). Twelve patients had preexisting valvular or congenital heart disease. Gram-positive cocci were the most common microorganisms. Complications included mitral regurgitation, subarachnoid hemorrhage, renal infarction, stroke, and a pulmonary embolus. The patients were divided into two groups: Group I consisted of 36 patients with definite vegetations by echocardiography, and Group II had 65 patients with no vegetations. In Group I, acute infective endocarditis was present in 35 patients, whereas only 4 patients had endocarditis in Group II. The sensitivity of two-dimensional echocardiography for detecting endocarditis was 90%. The specificity was 98%. The predictive accuracy for a positive test was 97%, and the predictive accuracy for a negative test was 94%. Thus, two-dimensional echocardiography appears to have a high sensitivity, specificity, and predictive value in the evaluation of patients with suspected endocarditis.
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Affiliation(s)
- A J Burger
- Department of Medicine, Marshall University School of Medicine, Huntington, West Virginia
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Bierbrier GS, Novick RJ, Guiraudon C, Wisenberg G, Boughner D. Left atrial bacterial mural endocarditis. Chest 1991; 99:757-9. [PMID: 1995240 DOI: 10.1378/chest.99.3.757] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
An unusual case of Staphylococcus aureus endocarditis confined to the mural left atrium is presented. Echocardiographic studies revealed a 1.5 x 2.0-cm vegetation mimicking a myxoma situated in the path of a mitral regurgitant jet on a color Doppler test. Emboli to upper and lower extremities and brain complicated the patient's preoperative course. Surgical excision and pathologic examination confirmed this rare occurrence.
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Affiliation(s)
- G S Bierbrier
- Department of Medicine, University Hospital, London, Ontario, Canada
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Leung WH, Lau CP, Tai YT, Wong CK, Cheng CH. Candida right ventricular mural endocarditis complicating indwelling right atrial catheter. Chest 1990; 97:1492-3. [PMID: 2347241 DOI: 10.1378/chest.97.6.1492] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Catheter-associated candidemia is a common problem in immunocompromised patients. A leukemic patient had Candida right ventricular mural endocarditis complicating an indwelling right atrial catheter. To our knowledge, this is the first reported case of Candida right ventricular mural vegetation visualized by two-dimensional echocardiography.
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Affiliation(s)
- W H Leung
- Department of Medicine, University of Hong Kong, Queen Mary Hospital
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