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Rito S, Oliveira Dias J, Rodrigues D, Martins P, Pires A. An Uncommon Presentation of Aortic Endarteritis. Cureus 2024; 16:e52515. [PMID: 38371058 PMCID: PMC10874254 DOI: 10.7759/cureus.52515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 02/20/2024] Open
Abstract
Endocarditis is an uncommon infectious complication of congenital heart disease (CHD), typically presenting with fever as its primary symptom; however, its occurrence may not always be accompanied by fever. This paper elaborates on a case involving a patient with surgically corrected Berry syndrome and residual aortic coarctation. The clinical presentation of aortic endarteritis in this case manifested as seizures attributed to a hemorrhagic stroke. In this paper, we aim to raise awareness of this infrequent complication of aortic coarctation, as it may present itself with cerebral hemorrhage due to septic microemboli, even in the absence of fever at its initial presentation.
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Affiliation(s)
- Sofia Rito
- Pediatric Cardiology, Hospital Pediátrico do Centro Hospitalar e Universitário de Coimbra, Coimbra, PRT
| | - Joao Oliveira Dias
- Pediatric Cardiology, Hospital Pediátrico do Centro Hospitalar e Universitário de Coimbra, Coimbra, PRT
| | - Dina Rodrigues
- Pediatric Cardiology, Hospital Pediátrico do Centro Hospitalar e Universitário de Coimbra, Coimbra, PRT
| | - Paula Martins
- Pediatric Cardiology, Hospital Pediátrico do Centro Hospitalar e Universitário de Coimbra, Coimbra, PRT
| | - António Pires
- Pediatric Cardiology, Hospital Pediátrico do Centro Hospitalar e Universitário de Coimbra, Coimbra, PRT
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Slouha E, Rood C, Burle VS, Al-Geizi H, Clunes LA, Kollias TF. Infective Endocarditis Following Aortic Valve Replacement: A Systematic Review. Cureus 2023; 15:e49048. [PMID: 38116334 PMCID: PMC10728577 DOI: 10.7759/cureus.49048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2023] [Indexed: 12/21/2023] Open
Abstract
Aortic valve replacement (AVR) successfully treats aortic valve stenosis and aortic regurgitation from aging or bicuspid aortic valves. The procedure intends to restore the obstructed left ventricular outflow tract (LVOT). AVR can be performed surgically (surgical aortic valve replacement (SAVR); open heart) or via transcatheter (transcatheter aortic valve replacement (TAVR)), typically done through a femoral approach as a minimally invasive procedure, allowing for quicker recovery and reduced hospital stays. AVR has many complications, including life-threatening ones, such as infective endocarditis (IE), retarding the recovery process and increasing mortality following surgery. IE is an uncommon and deadly condition that involves multiple organ systems and is caused by bacteremia stemming from a microorganism that enters the bloodstream. Many manifestations are involved in the development of IE, such as fevers, flu-like symptoms, splinter hemorrhages, Osler nodes, abscesses, and vegetations found on the valves at the leaflets. Vegetations and abscesses tend to create further complications, such as stroke and acute kidney injury, as emboli block blood flow, leading to ischemia and damage. This paper aims to evaluate the difference in SAVR- and TAVR-associated IE, as the goal is to elucidate a danger that diminishes the positive effects of either procedure despite its rarity. Studies have been inconclusive in determining whether or not there is a trend, let alone a difference in incident rates. Both procedures share similar risk factors, but SAVR-associated IE is usually caused by Staphylococcus aureus, and studies indicate possibly Enterococcus spp. in TAVR-associated IE. Incident rates of IE are much higher than they should be, whether or not they differ between procedures, and future research needs to consider the pathways and risk factors that can be used to reduce the occurrence of AVR-associated IE.
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Affiliation(s)
- Ethan Slouha
- Anatomical Sciences, St. George's University School of Medicine, St. George's, GRD
| | - Catherine Rood
- Pharmacology, St. George's University School of Medicine, St. George's, GRD
| | - Venkata Sathya Burle
- Anatomical Sciences, St. George's University School of Medicine, St. George's, GRD
| | - Hanin Al-Geizi
- Pharmacology, St. George's University School of Medicine, St. George's, GRD
| | - Lucy A Clunes
- Pharmacology, St George's University, St. George's, GRD
| | - Theofanis F Kollias
- Microbiology, Immunology and Pharmacology, St. George's University School of Medicine, St. George's, GRD
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Ramos-Martínez A, Domínguez F, Muñoz P, Marín M, Pedraz Á, Fariñas MC, Tascón V, de Alarcón A, Rodríguez-García R, Miró JM, Goikoetxea J, Ojeda-Burgos G, Escrihuela-Vidal F, Calderón-Parra J. Clinical presentation, microbiology, and prognostic factors of prosthetic valve endocarditis. Lessons learned from a large prospective registry. PLoS One 2023; 18:e0290998. [PMID: 37682961 PMCID: PMC10490835 DOI: 10.1371/journal.pone.0290998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/19/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Prosthetic valve endocarditis (PVE) is a serious infection associated with high mortality that often requires surgical treatment. METHODS Study on clinical characteristics and prognosis of a large contemporary prospective cohort of prosthetic valve endocarditis (PVE) that included patients diagnosed between January 2008 and December 2020. Univariate and multivariate analysis of factors associated with in-hospital mortality was performed. RESULTS The study included 1354 cases of PVE. The median age was 71 years with an interquartile range of 62-77 years and 66.9% of the cases were male. Patients diagnosed during the first year after valve implantation (early onset) were characterized by a higher proportion of cases due to coagulase-negative staphylococci and Candida and more perivalvular complications than patients detected after the first year (late onset). In-hospital mortality of PVE in this series was 32.6%; specifically, it was 35.4% in the period 2008-2013 and 29.9% in 2014-2020 (p = 0.031). Variables associated with in-hospital mortality were: Age-adjusted Charlson comorbidity index (OR: 1.15, 95% CI: 1.08-1.23), intracardiac abscess (OR:1.78, 95% CI:1.30-2.44), acute heart failure related to PVE (OR: 3. 11, 95% CI: 2.31-4.19), acute renal failure (OR: 3.11, 95% CI:1.14-2.09), septic shock (OR: 5.56, 95% CI:3.55-8.71), persistent bacteremia (OR: 1.85, 95% CI: 1.21-2.83) and surgery indicated but not performed (OR: 2.08, 95% CI: 1.49-2.89). In-hospital mortality in patients with surgical indication according to guidelines was 31.3% in operated patients and 51.3% in non-operated patients (p<0.001). In the latter group, there were more cases of advanced age, comorbidity, hospital acquired PVE, PVE due to Staphylococcus aureus, septic shock, and stroke. CONCLUSIONS Not performing cardiac surgery in patients with PVE and surgical indication, according to guidelines, has a significant negative effect on in-hospital mortality. Strategies to better discriminate patients who can benefit most from surgery would be desirable.
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Affiliation(s)
- Antonio Ramos-Martínez
- Unit of Infectious Diseases, Department of Internal Medicine, University Hospital Puerta de Hierro, Majadahonda, Spain
- Instituto Investigación Sanitaria Puerta de Hierro—Segovia de Arana (IDIPHSA), Majadahonda, Spain
- Autonomous University of Madrid, Majadahonda, Spain
| | - Fernando Domínguez
- Department of Cardiology, University Hospital Puerta de Hierro, Majadahonda, Spain
| | - Patricia Muñoz
- Department of Cardiology, University Hospital Puerta de Hierro, Majadahonda, Spain
- Department of Clinical Microbiology and Infectious Diseases, University General Hospital Gregorio Marañón, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
- Complutense University of Madrid, Madrid, Spain
| | - Mercedes Marín
- Department of Clinical Microbiology and Infectious Diseases, University General Hospital Gregorio Marañón, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
| | - Álvaro Pedraz
- Department of Cardiac Surgery, University General Hospital Gregorio Marañón, Madrid, Spain
| | - Mª Carmen Fariñas
- Department of Infectious Diseases, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
- CIBER de Enfermedades Infecciosas-CIBERINFEC (CB21/13/00068), Institute of Health Carlos III, Madrid, Spain
- University of Cantabria, Santander, Spain
| | - Valentín Tascón
- Department of Cardiovascular Surgery, University Hospital Marqués de Valdecilla, Santander, Spain
| | - Arístides de Alarcón
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Infectious Diseases Research Group Institute of Biomedicine of Seville (IBiS), Seville, Spain
- University of Seville/CSIC/University, Seville, Spain
- Hospital Virgen del Rocío, Seville, Spain
| | - Raquel Rodríguez-García
- Department of Intensive Medicine, University Hospital Central of Asturias, Oviedo, Spain
- University of Oviedo, Oviedo, Spain
| | - José María Miró
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - Josune Goikoetxea
- Department of Infectious Diseases, University Hospital de Cruces, Bilbao, Spain
| | - Guillermo Ojeda-Burgos
- Department of Internal Medicine, University Hospital Virgen de la Victoria, Málaga, Spain
| | - Francesc Escrihuela-Vidal
- University of Barcelona, Barcelona, Spain
- Department of Infectious Diseases, University Hospital of Bellvitge, Barcelona, Spain
- Research Institut of Biomedicine of Bellvitge, Barcelona, Spain
| | - Jorge Calderón-Parra
- Unit of Infectious Diseases, Department of Internal Medicine, University Hospital Puerta de Hierro, Majadahonda, Spain
- Instituto Investigación Sanitaria Puerta de Hierro—Segovia de Arana (IDIPHSA), Majadahonda, Spain
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Heuts S, Schalla S, Ramaekers MJFG, Bidar E, Mihl C, Wildberger JE, Adriaans BP. Imaging surveillance for complications after primary surgery for type A aortic dissection. Heart 2022; 109:96-101. [PMID: 35321890 DOI: 10.1136/heartjnl-2022-320881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 03/03/2022] [Indexed: 02/04/2023]
Abstract
Acute type A aortic dissection (ATAAD) is a life-threatening condition that requires emergency surgery to avert fatal outcome. Conventional surgical procedures comprise excision of the entry tear and replacement of the proximal aorta with a synthetic vascular graft. In patients with DeBakey type I dissection, this approach leaves a chronically dissected distal aorta, putting them at risk for progressive dilatation, dissection propagation and aortic rupture. Therefore, ATAAD survivors should undergo serial imaging for evaluation of the aortic valve, proximal and distal anastomoses, and the aortic segments beyond the distal anastomosis. The current narrative review aims to describe potential complications in the early and late phases after ATAAD surgery, with focus on their specific imaging findings.
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Affiliation(s)
- Samuel Heuts
- Department of Cardiothoracic Surgery, Maastricht Universitair Medisch Centrum+, Maastricht, Limburg, The Netherlands
| | - Simon Schalla
- Department of Cardiology, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Mitch J F G Ramaekers
- Department of Cardiology, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Elham Bidar
- Department of Cardiothoracic Surgery, Maastricht Universitair Medisch Centrum+, Maastricht, Limburg, The Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Casper Mihl
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Joachim E Wildberger
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Bouke P Adriaans
- Department of Cardiology, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, Limburg, The Netherlands
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Xu B, Reyaldeen R. Ascending aortic graft infection - an expanding role for multi-modality cardiac imaging. Int J Cardiol 2021; 333:246-248. [PMID: 33794230 DOI: 10.1016/j.ijcard.2021.03.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 03/24/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Bo Xu
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, OH, USA.
| | - Reza Reyaldeen
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, OH, USA
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