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Saha B, Wien E, Fancher N, Kahili-Heede M, Enriquez N, Velasco-Hughes A. Heyde's syndrome: a systematic review of case reports. BMJ Open Gastroenterol 2022; 9:bmjgast-2021-000866. [PMID: 35534046 PMCID: PMC9086603 DOI: 10.1136/bmjgast-2021-000866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/27/2022] [Indexed: 11/12/2022] Open
Abstract
Objective Heyde’s syndrome (HS), a rare condition characterised by a unique relationship between severe aortic stenosis and angiodysplasia, is often diagnosed late increasing the risk for a prolonged hospital course and mortality in the elderly. The leading hypothesis explaining the aetiology of HS is acquired von Willebrand syndrome (AVWS) but not all studies support this claim. While individual cases of HS have been reported, here we present the first systematic review of case reports and focus on the prevalence of AVWS. Design A systematic search was conducted through PubMed/MEDLINE, CINAHL-EBSCO, Web of Science and Google Scholar since inception. The resulting articles were screened by two independent reviewers based on inclusion criteria that the article must be a case report/series or a letter to the editor in English describing HS in an adult patient. Results Seventy-four articles encompassing 77 cases met the inclusion criteria. The average age was 74.3±9.3 years old with a slight female predominance. The small intestine, especially the jejunum, was the most common location for bleeding origin. Capsule endoscopy and double balloon enteroscopy were superior at identifying bleeding sources than colonoscopy (p=0.0027 and p=0.0095, respectively) and oesophagogastroduodenoscopy (p=0.0006 and p=0.0036, respectively). The mean duration from symptom onset to diagnosis/treatment of HS was 23.8±39 months. Only 27/77 cases provided evidence for AVWS. Surgical and transcutaneous aortic valve replacement (AVR) were superior at preventing rebleeding than non-AVR modalities (p<0.0001). Conclusion Further research is warranted for a stronger understanding and increased awareness of HS, which may hasten diagnosis and optimal management.
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Affiliation(s)
- Bibek Saha
- John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, Hawaii, USA
| | - Eric Wien
- John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, Hawaii, USA.,Internal Medicine Residency Program, University of Hawai'i at Mānoa, Honolulu, Hawaii, USA
| | - Nicholas Fancher
- John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, Hawaii, USA
| | - Melissa Kahili-Heede
- John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, Hawaii, USA
| | - Nathaniel Enriquez
- John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, Hawaii, USA.,Internal Medicine Residency Program, University of Hawai'i at Mānoa, Honolulu, Hawaii, USA
| | - Alena Velasco-Hughes
- John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, Hawaii, USA.,Queen's Medical Group Hospitalist Program, Queen's Medical Center, Honolulu, Hawaii, USA
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Devarakonda PK, Dhulipala VR, Karki M, Ayala-Rodriguez C, Reddy S. A Rarely Reported Case of Enterococcus faecalis Bacteremia Causing Infective Endocarditis and Osteomyelitis. Cureus 2022; 14:e22522. [PMID: 35345720 PMCID: PMC8956490 DOI: 10.7759/cureus.22522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 11/05/2022] Open
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Kwang Tay Y, Yin Tay J, Naqash N, Cashin P. Infective endocarditis and infected aneurysm of splenic artery post colonoscopy. Ann Gastroenterol 2013; 26:170-172. [PMID: 24714871 PMCID: PMC3959929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 07/08/2012] [Indexed: 11/29/2022] Open
Abstract
Colonoscopy, a relatively non-invasive procedure, has been associated with several complications including perforation, hemorrhage and abdominal pain. Post-colonoscopy bacteremia can occur up to 4.4% of the time but is almost always transient without significant clinical sequelae. Post-colonoscopy infective endocarditis, on the other hand, is a rare occurrence associated with high rates of mortality and morbidity, and may be further complicated by aneurysm of splenic artery. Current definitive treatment of infected aneurysm is surgical ligation and excision with or without vascular anastomosis. If surgery is contraindicated, endovascular graft and transcatheter embolization may be the preferred treatment options. This is a case report of infective endocarditis and infected aneurysm of splenic artery presenting two weeks after elective colonoscopy.
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Affiliation(s)
- Yeng Kwang Tay
- Department of Upper Gastrointestinal Surgery, Southern Helath (Yeng Kwang Tay, Niyaz Naqash, Paul Cashin)
| | - Jia Yin Tay
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne (Jia Yin Tay), Victoria, Australia
| | - Niyaz Naqash
- Department of Upper Gastrointestinal Surgery, Southern Helath (Yeng Kwang Tay, Niyaz Naqash, Paul Cashin)
| | - Paul Cashin
- Department of Upper Gastrointestinal Surgery, Southern Helath (Yeng Kwang Tay, Niyaz Naqash, Paul Cashin),
Correspondence to: Mr. Paul Cashin, Upper Gastrointestinal Surgery Unit, Monash Medical Centre, 246 Clayton Road, Clayton, 3168 Victoria, Australia, Tel.: +61 3 9594 6666, Fax: +61 3 9594 6053, e-mail:
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4
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Pendsé DA, Taylor SA. Complications of CT colonography: a review. Eur J Radiol 2012; 82:1159-65. [PMID: 22595505 DOI: 10.1016/j.ejrad.2012.04.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Accepted: 04/04/2012] [Indexed: 12/23/2022]
Abstract
Since its inception, one of the main advantages of computed tomography colonography (CTC) over colonoscopy has been its assumed superior safety profile. However CTC is not without complication and adverse events are well described. Although the risks of insufflation, bowel preparation, contrast media and radiation dose are very small, they are not insignificant. This review discusses the potential hazards and complications associated with the technique, and discuss precautions, which may lessen the risk of occurrence.
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Affiliation(s)
- D A Pendsé
- Department of Imaging, University College London Hospitals NHS Foundation Trust, London, UK.
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Fernández Guerrero ML, Goyenechea A, Verdejo C, Roblas RF, de Górgolas M. Enterococcal endocarditis on native and prosthetic valves: a review of clinical and prognostic factors with emphasis on hospital-acquired infections as a major determinant of outcome. Medicine (Baltimore) 2007; 86:363-377. [PMID: 18004181 DOI: 10.1097/md.0b013e31815d5386] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Enterococci are the third leading cause of infectious endocarditis, and despite advances in diagnosis and treatment, the mortality of enterococcal endocarditis has not changed in recent decades. Although variables such as advanced age, cardiac failure, and brain emboli have been recognized as risk factors for mortality, cooperative multi-institutional studies have not assessed the role of other variables, such as nosocomial acquisition of infection, the presence of comorbidities, or the changing antimicrobial susceptibility of enterococci, as factors determining prognosis.We conducted the current study to determine the risk factors for mortality in patients with enterococcal endocarditis in a single institution. We reviewed 47 consecutive episodes of enterococcal endocarditis in 44 patients diagnosed according to the modified Duke criteria from a retrospective cohort study of cases of infectious endocarditis. The main outcome measure was inhospital mortality. We applied stepwise logistic regression analysis to identify risk factors for mortality.Predisposing heart conditions were observed in 86.3% of patients, and 17 had prosthetic valve endocarditis. A portal of entry was suspected or determined in 38.2%; the genitourinary tract was the most common source of the infection (29.7%). Comorbidities were present in 52.2% of cases. Twelve episodes (25.5%) were acquired during hospitalization. Only 3 isolates of Enterococcus faecalis were highly resistant to gentamicin. Eighteen patients (40.9%) needed valve replacement due to cardiac failure or relapse. Comparing cases of native valve and prosthetic valve endocarditis, we found no differences regarding complications, the need for surgical treatment, or mortality. Eight of 44 (18%) episodes were fatal. Age over 70 years (p = 0.05), heart failure (odds ratio [OR], 1.61; 95% confidence interval [CI], 1.15-2.25; p = 0.001), presence of 1 or more comorbidities (OR, 3.2; 95% CI, 1.11-9.39; p = 0.02), and nosocomial acquisition (OR, 8.05; 95% CI, 1.50-43.2; p = 0.01) were associated with mortality. In the multivariate analysis, only nosocomial acquisition increased the risk of mortality. In patients with enterococcal endocarditis, nosocomial acquisition of infection is an important factor determining outcome. As the incidence of bacteremia and the population of elderly people at risk continue to grow, the hazard of acquiring nosocomial enterococcal endocarditis may increase; hence, major emphasis must be put on prevention.
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Affiliation(s)
- Manuel L Fernández Guerrero
- From Divisions of Infectious Diseases (Department of Medicine) and Clinical Microbiology. Fundación Jiménez Dìaz, Universidad Autónoma de Madrid, Madrid, Spain
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Malani AN, Aronoff DM, Bradley SF, Kauffman CA. Cardiobacterium hominis endocarditis: Two cases and a review of the literature. Eur J Clin Microbiol Infect Dis 2006; 25:587-95. [PMID: 16955250 PMCID: PMC2276845 DOI: 10.1007/s10096-006-0189-9] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cardiobacterium hominis, a member of the HACEK group (Haemophilus parainfluenzae, Haemophilus aphrophilus, and Haemophilus paraphrophilus, Actinobacillus actinomycetemcomitans, C. hominis, Eikenella corrodens, and Kingella species), is a rare cause of endocarditis. There are 61 reported cases of C. hominis infective endocarditis in the English-language literature, 15 of which involved prosthetic valve endocarditis. There is one reported case of C. hominis after upper endoscopy and none reported after colonoscopy. Presented here are two cases of C. hominis prosthetic valve endocarditis following colonoscopy and a review of the microbiological and clinical features of C. hominis endocarditis. Patients with C. hominis infection have a long duration of symptoms preceding diagnosis (138+/-128 days). The most common symptoms were fever (74%), fatigue/malaise (53%), weight loss/anorexia (40%), night sweats (24%), and arthralgia/myalgia (21%). The most common risk factors were pre-existing cardiac disease (61%), the presence of a prosthetic valve (28%), and history of rheumatic fever (20%). Of the 61 cases reviewed here, the aortic valve was infected in 24 (39%) and the mitral valve in 19 (31%) patients. The average duration of blood culture incubation before growth was detected was 6.3 days (range, 2-21 days). Complications were congestive heart failure (40%), central nervous system (CNS) emboli (21%), arrhythmia (16%), and mycotic aneurysm (9%). C. hominis is almost always susceptible to beta-lactam antibiotics. Ceftriaxone is recommended by the recently published American Heart Association guidelines. The prognosis of C. hominis native valve and prosthetic valve endocarditis is favorable. The cure rate among 60 patients reviewed was 93% (56/60). For prosthetic valve endocarditis, the cure rate was 16/17 (94%). Valve replacement was required in 27 (45%) cases.
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Affiliation(s)
- A N Malani
- Division of Infectious Diseases, University of Michigan Medical School, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, 2215 Fuller Road, Ann Arbor, MI 48105, USA.
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Allocca G, Slavich G, Nucifora G, Slavich M, Frassani R, Crapis M, Badano L. Successful treatment of polymicrobial multivalve infective endocarditis. Int J Cardiovasc Imaging 2006; 23:501-5. [PMID: 17086366 DOI: 10.1007/s10554-006-9147-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2006] [Accepted: 08/02/2006] [Indexed: 11/29/2022]
Abstract
A 57-year-old man presented with triple valve infective endocarditis. There were vegetations on the tricuspid, mitral, and aortic valve. He had multiple complications such as pulmonary abscess, severe anaemia, and congestive heart failure. His general condition was extremely poor. Intensive medical therapy, such as blood transfusion, mechanical ventilation, and inotropic support, allowed him to tolerate surgery. Triple valve replacement was successfully performed without major complication. Vegetation cultures grew Streptococcus bovis and Enterecoccus faecalis. At 1 year follow-up, the patient is alive in NYHA functional class I.
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Affiliation(s)
- Giuseppe Allocca
- Cardiology Unit, Department of Cardiopulmonary Sciences, A.O. S Maria della Misericordia, P. le S Maria della Misericordia 15, 33100 Udine, Italy.
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