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Monari C, Molinari D, Cornelli A, Alessio L, Coppolino F, Barbareschi C, De Pascalis S, Torella M, Cimmino G, De Feo M, Coppola N, Formisano T. An Unusual Case of a Double Tricuspid and Mitral Valves Infective Endocarditis Complicated by Multiple Septic Embolisms Secondary to an Atrial Septal Defect: A Case Report and Review of Literature. Infect Dis Rep 2023; 15:494-503. [PMID: 37736996 PMCID: PMC10514809 DOI: 10.3390/idr15050049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 09/23/2023] Open
Abstract
Multivalvular endocarditis (MVE) is an uncommon infection that mostly involves mitral and aortic valves, and it is related to a higher risk of congestive heart failure and a higher mortality. We described a case of a bilateral MVE and performed a review of the literature on similar clinical cases. We reported an unusual case of a 68-year-old male patient with a tricuspid and mitral infective endocarditis due to a methicillin-resistant Staphylococcus aureus complicated by multiple right- and left-sided septic embolization (lungs, brain, spleen, L2-L3 vertebral bones) due to an unknown atrial septal defect identified and repaired during cardiac surgery. Despite the severity of the clinical case, the patient experienced a good clinical outcome also thanks to a multidisciplinary approach. We identified 21 case reports describing bilateral MVE. A multidisciplinary approach is essential in the management of valve diseases to improve the prognosis of patients, especially in bilateral MVE.
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Affiliation(s)
- Caterina Monari
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Via L. Armanni 5, 80131 Naples, Italy; (C.M.); (A.C.); (L.A.); (S.D.P.)
| | - Daniele Molinari
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, Piazza Miraglia 2, 80138 Naples, Italy; (D.M.); (C.B.); (G.C.); (T.F.)
| | - Alessandro Cornelli
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Via L. Armanni 5, 80131 Naples, Italy; (C.M.); (A.C.); (L.A.); (S.D.P.)
| | - Loredana Alessio
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Via L. Armanni 5, 80131 Naples, Italy; (C.M.); (A.C.); (L.A.); (S.D.P.)
| | - Francesco Coppolino
- Department of Women, Child and General and Specialized Surgery, Section of Anaesthesiology, University of Campania Luigi Vanvitelli, Piazza Miraglia 2, 80138 Naples, Italy;
| | - Consiglia Barbareschi
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, Piazza Miraglia 2, 80138 Naples, Italy; (D.M.); (C.B.); (G.C.); (T.F.)
| | - Stefania De Pascalis
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Via L. Armanni 5, 80131 Naples, Italy; (C.M.); (A.C.); (L.A.); (S.D.P.)
| | - Michele Torella
- Department of Translational Medical Sciences, Section of Cardiac Surgery and Heart Transplant, University of Campania Luigi Vanvitelli, via L. Bianchi c/o Ospedale Monaldi, 80131 Naples, Italy; (M.T.); (M.D.F.)
| | - Giovanni Cimmino
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, Piazza Miraglia 2, 80138 Naples, Italy; (D.M.); (C.B.); (G.C.); (T.F.)
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania Luigi Vanvitelli, via L. Bianchi c/o Ospedale Monaldi, 80131 Naples, Italy
| | - Marisa De Feo
- Department of Translational Medical Sciences, Section of Cardiac Surgery and Heart Transplant, University of Campania Luigi Vanvitelli, via L. Bianchi c/o Ospedale Monaldi, 80131 Naples, Italy; (M.T.); (M.D.F.)
| | - Nicola Coppola
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Via L. Armanni 5, 80131 Naples, Italy; (C.M.); (A.C.); (L.A.); (S.D.P.)
| | - Tiziana Formisano
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, Piazza Miraglia 2, 80138 Naples, Italy; (D.M.); (C.B.); (G.C.); (T.F.)
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Srdanović I, Stefanović M, Miljković T, Bjelić S, Trajković M, Pantić T, Velicki L, Milovančev A. Pulmonary Valve Endocarditis during and beyond Euro ENDO Registry: A Single Center Case Series. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1213. [PMID: 37512025 PMCID: PMC10385559 DOI: 10.3390/medicina59071213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/12/2023] [Accepted: 06/27/2023] [Indexed: 07/30/2023]
Abstract
Background: Pulmonary valve infective endocarditis (PVIE) is a rare form of infective endocarditis (IE) and is associated with high mortality and severe complications. Guidelines for treatment of this form of IE are scarce and based on general recommendations. We report a case series of PVE. Detailed Case Description: Case 1-A 36-year-old female with congenital pulmonary artery stenosis, dyspnea and leg edema symptoms for 2 months. Blood cultures yielded Staphylococcus spp. and Corynebacterium sp., and echocardiography revealed multiple floating vegetation at the pulmonic valve and surrounding structures. The clinical course was complicated with sepsis and multi-organ failure. Urgent surgery with pulmonary homograft implantation resulted in successful five-year outcome. Case 2-In a 38-year-old male with previous tetralogy of Fallot correction and symptoms of fatigue, fever, myalgia, and photophobia, echocardiography was suggestive of PVIE. The clinical course was complicated with septic shock, multi-organ failure, ischemic stroke with hemorrhagic transformation and death on the 12th day of hospitalization. Case 3-A 41-year-old male without previous medical history was hospitalized due to prolonged fatigue, fever, dyspnea, and leg edema. He was diagnosed with multi-valve infective endocarditis, affecting the aortic, tricuspid, and pulmonary valve. Acute heart failure and hemodynamic instability indicated urgent surgery with aortic valve replacement and reconstruction of the tricuspid and pulmonary valves. At four-year follow up he was doing well. Conclusion: Symptoms in PVIE may be versatile, and diagnosis is often delayed. High level of suspicion, early recognition, and echocardiography are cornerstones in diagnostics. Despite the standpoint that medical therapy is first-line, the role of surgery needs to be advocated in particular cases.
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Affiliation(s)
- Ilija Srdanović
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
- Institute of Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Maja Stefanović
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
- Institute of Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Tatjana Miljković
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
- Institute of Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Snežana Bjelić
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
- Institute of Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Miloš Trajković
- Institute of Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Teodora Pantić
- Institute of Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Lazar Velicki
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
- Institute of Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Aleksandra Milovančev
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
- Institute of Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
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Hasnie AA, Miller N, Seghatol-Eslami F. Visualization of bivalvular endocarditis and transeptal cardiac defect via transoesophageal echocardiography. Eur Heart J Case Rep 2021; 5:ytab507. [PMID: 35047740 PMCID: PMC8759479 DOI: 10.1093/ehjcr/ytab507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/05/2021] [Accepted: 11/30/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Ammar A Hasnie
- Department of Medicine, University of Alabama at Birmingham, 1720 2nd Ave S, BDB 327, Birmingham, AL 35233, USA
| | - Neal Miller
- Department of Cardiology, University of Alabama at Birmingham, 1720 2nd Ave S, BDB 327, Birmingham, AL 35233, USA
| | - Frank Seghatol-Eslami
- Department of Cardiology, University of Alabama at Birmingham, 1720 2nd Ave S, BDB 327, Birmingham, AL 35233, USA
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Bolat K, Yildirim M, Baltali S, Karabag T. Biventricular Native Valve Endocarditis in a Patient with No Cardiac Disease and Predisposing Factor - Case Report. MÆDICA 2021; 16:307-312. [PMID: 34621357 DOI: 10.26574/maedica.2020.16.2.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background: Infective endocarditis is a challenging clinical situation that causes numerous complications. Multi-valvular endocarditis, which is seen less frequently than single valvular endocarditis, is often a fatal disease. In this article, we present a case of endocarditis with native mitral and tricuspid valve involvement in a patient without any underlying predisposing factors. Case report:A 62-year-old patient was admitted to hospital with shortness of breath without any underlying predisposing factors. Covid-19 PCR swab was negative. Transthoracic echocardiography revealed bi-sided valve endocarditis with mitral and tricuspid valve involvement. The patient was taken to the intensive care unit. Transthoracic and transesophageal echocardiography revealed valvular involvement, flail mitrale with severe regurgitation on both valvules. The patient and patient's relatives refused the valvular operation because of the higher risk. Despite the antibiotic treatment, the general condition of the patient deteriorated and died. Conclusion:Multi-valvular endocarditis is a serious disorder with high mortality. In diagnosis, imaging procedures should be utilized as early as possible. Staphylococci are the most common pathogens in such cases, in which early diagnosis and treatment, particularly using a surgical approach, are appropriate.
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Affiliation(s)
- Kubra Bolat
- Saglik Bilimleri Universitesi, Istanbul Education and Research Hospital, Departments of Anesthesia and Reanimation, Istanbul, Turkey
| | - Murat Yildirim
- Saglik Bilimleri Universitesi, Istanbul Education and Research Hospital, Departments of Anesthesia and Reanimation, Istanbul, Turkey
| | - Sevim Baltali
- Saglik Bilimleri Universitesi, Istanbul Education and Research Hospital, Departments of Anesthesia and Reanimation, Istanbul, Turkey
| | - Turgut Karabag
- Saglik Bilimleri Universitesi, Istanbul Education and Research Hospital, Department of Cardiology, Istanbul, Turkey
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Surgical Treatment of Infective Endocarditis in Pulmonary Position-15 Years Single Centre Experience. ACTA ACUST UNITED AC 2019; 55:medicina55090608. [PMID: 31546957 PMCID: PMC6780819 DOI: 10.3390/medicina55090608] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/10/2019] [Accepted: 09/11/2019] [Indexed: 12/19/2022]
Abstract
Background and Objectives: Infective endocarditis in the pulmonary position is a rare disease. Isolated pulmonary valve endocarditis is extremely rare. The aim of our study was to assess patients who were treated surgically for pulmonary endocarditis at our institution from January 2003 to December 2017. Materials and Methods: We analyze eight cases of infectious endocarditis in pulmonary position out of 293 patients who were operated for infective endocarditis (2.7%, 8/293). Only two of these eight patients were not related to congenital heart malformation. They were followed for early and late mortality, long-term survival, postoperative morbidity and reoperations. Results: Among six patients suffering from congenital heart disease, four patients underwent corrections of pulmonary valve malformation previously, and their infected grafts were replaced by two allografts and two xenografts. The two other patients had replaced their infected pulmonary valves with allografts. Two non-congenital patients with pulmonary valve endocarditis underwent valve replacement with biological prosthesis. All patients survived the early postoperative course. The mean follow-up time was 9.1 (interquartile range (IQR), 5.3-12.6) years. The long-term follow-up included seven patients. One patient (12.5%, 1/8) died more than 4 years after the surgery due to sepsis. Pulmonary endocarditis was the rarest endocarditis treated surgically (p < 0.001). Conclusion: Surgery for infective endocarditis in the pulmonary position (IEPP) is an effective method of treatment with excellent early outcome and good late results despite a very uncommon pathology and few operations being performed. Surgery performed earlier may make the procedure less radical.
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Pan JH. Rare Simultaneous Left and Right-Sided Native Valve Infective Endocarditis Caused by Rare Bacterium. Int Heart J 2019; 60:474-476. [PMID: 30626769 DOI: 10.1536/ihj.18-347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Simultaneous left and right-sided native valve infective endocarditis (IE) is rare. Staphylococcus aureus was the predominant organism for bilateral IE. Shunt diseases are common risk factors of both-sided IE. Streptococcus anginosus (S. anginosus) is usually associated with pyogenic infections, but rarely a cause of IE. Here we present an extremely rare case of simultaneous left and right-sided native valve IE affecting the mitral and tricuspid valves caused by S. anginosus in an adult patient that has not been reported in the literature previously, particularly without the most frequent predisposing factors of IE. A 66-year-old man was admitted due to generalized fatigue, chills, malaise, and intermittent fevers for 1 year. A grade III-IV/VI systolic murmur at the mitral area and a III/VI systolic murmur at the tricuspid area were noted on physical examination. Laboratory evaluation revealed an elevated erythrocyte sedimentation rate and C-reactive protein level, and high fasting blood glucose. Blood culture was positive for S. anginosus. Echocardiography revealed vegetations in both sides of the heart: a large mitral valve vegetation with severe mitral regurgitation, as well as another vegetation on the tricuspid valve with moderate regurgitation. The case highlights a rare pathogen of both-sided IE, a rare presentation of S. anginosus infection, and several points worthy of note in echocardiography of IE.
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Affiliation(s)
- Jian-Hong Pan
- Department of Internal Medicine, Tianjin NanKai Hospital
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Garg N, Nayyar M, Khouzam RN, Salem SA, Ardeshna D. Peri-procedural antibiotic prophylaxis in ventricular septal defect: a case study to re-visit guidelines. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:18. [PMID: 29404364 DOI: 10.21037/atm.2017.11.11] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The current American Heart Association (AHA)/American College of Cardiology (ACC) guidelines do not recommend antibiotic prophylaxis for infective endocarditis (IE) in patients with acyanotic congenital valvular heart disease due to lack of any proven benefit and potential harm associated with antibiotics. As recognized by the guidelines, some acyanotic congenital heart disease, such as ventricular septal defects (VSDs), are associated with a high velocity jet and pose a greater risk of peri-procedural endocarditis. We suggest that an acyanotic congenital heart disease with high velocity jet should be considered for antibiotic prophylaxis for IE.
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Affiliation(s)
- Nadish Garg
- Department of Cardiology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Mannu Nayyar
- Department of Cardiology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Rami N Khouzam
- Department of Cardiology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Salem A Salem
- Department of Cardiology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Devarshi Ardeshna
- Medical Student, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Fernando RJ, Johnson SD, Augoustides JG, Patel PA, Gutsche JT, Dashiell JM, Feinman JW, Zhou E, Weiss SJ, Goldhammer JE, Panikkath PV, Gerstein NS. Simultaneous Right-Sided and Left-Sided Infective Endocarditis: Management Challenges in a Multidisciplinary Setting. J Cardiothorac Vasc Anesth 2017; 32:1041-1049. [PMID: 29249580 DOI: 10.1053/j.jvca.2017.07.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Indexed: 02/08/2023]
Affiliation(s)
- Rohesh J Fernando
- Cardiothoracic Section, Department of Anesthesiology, Wake Forest University School of Medicine, Winston Salem, NC
| | - Sean D Johnson
- Cardiothoracic Section, Department of Anesthesiology, Wake Forest University School of Medicine, Winston Salem, NC
| | - John G Augoustides
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Prakash A Patel
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jacob T Gutsche
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jillian M Dashiell
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jared W Feinman
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Elizabeth Zhou
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Stuart J Weiss
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jordan E Goldhammer
- Adult Cardiothoracic Anesthesiology, Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Pramod V Panikkath
- Division of Cardiac Anesthesia, Department of Anesthesiology, University of New Mexico, Albuquerque, NM
| | - Neal S Gerstein
- Division of Cardiac Anesthesia, Department of Anesthesiology, University of New Mexico, Albuquerque, NM
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Li D, Zhu Z, Zheng X, Wang W, Xu R, Liu K. Gemella morbillorum endocarditis of pulmonary valve:a case report. J Cardiothorac Surg 2017; 12:16. [PMID: 28335795 PMCID: PMC5364661 DOI: 10.1186/s13019-017-0579-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 03/07/2017] [Indexed: 11/23/2022] Open
Abstract
Background Pulmonary valve infective endocarditis is a rare finding for endocarditis. Infective endocarditis caused by Gemella morbillorum remains a scanty occurrence. Case presentation This is a case reported of a 28-year-old Chinese male with endocarditis caused by pulmonary valve infection of Gemella morbillorum associated with congenital ventricular septal defect, atrial septal defect and double-chambered right ventricle. The patient presented with fever, shortness of breath, progressively worsening exertional fatigue, dyspnea and weight loss for 3 months. The diagnosis was made with transthoracic echocardiogram, blood cultures, and post-operative pathology. The patient developed congestive heart failure and was managed with aggressive antibiotic therapy followed by surgery. He underwent replacement of the pulmonary valve with an aortic bioprosthetic valve, repair of ventricular septal defect and atrial septal defect, reconstruction of the right ventricular outlflow tract, and excision of vegetations. His postoperative recovery was uneventful. No bacteria were isolated from the excised tissues. He was asymptomatic without recurrence at 3-month follow-up. Conclusions The rare pathogen such as Gemella morbillorum can be the cause of infective endocarditis and timely surgical repair is necessary if the infection is refractory or there is progression of congestive heart failure under antibiotic cover.
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Affiliation(s)
- Dan Li
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University, 218 Ziqiang Street, Nanguan District, Changchun, Jilin, 130041, People's Republic of China
| | - Zhicheng Zhu
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University, 218 Ziqiang Street, Nanguan District, Changchun, Jilin, 130041, People's Republic of China
| | - Xiaomei Zheng
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University, 218 Ziqiang Street, Nanguan District, Changchun, Jilin, 130041, People's Republic of China
| | - Weitie Wang
- Department of Cardiovascular Surgery, The First Hospital of Tianjin, No. 186 Nankou Road, Tianjin, 300232, People's Republic of China
| | - Rihao Xu
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University, 218 Ziqiang Street, Nanguan District, Changchun, Jilin, 130041, People's Republic of China
| | - Kexiang Liu
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University, 218 Ziqiang Street, Nanguan District, Changchun, Jilin, 130041, People's Republic of China.
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