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Jamil Y, Akinleye A, Mirzaei M, Lempel M, Farhat K, Pan S. Candida endocarditis: Update on management considerations. World J Cardiol 2023; 15:469-478. [PMID: 37900901 PMCID: PMC10600790 DOI: 10.4330/wjc.v15.i10.469] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/23/2023] [Accepted: 09/06/2023] [Indexed: 10/24/2023] Open
Abstract
The rise in incidence rates of invasive candidiasis warrants an increase in attention and efforts toward preventing and treating this virulent infection. Cardiac involvement is one of the most feared sequelae and has a poor prognosis. Despite the introduction of several novel antifungal agents over the past quarter century, complications and mortality rates due to Candida endocarditis have remained high. Although fungal endocarditis has a mechanism similar to bacterial endocarditis, no specific diagnostic criteria or algorithm exists to help guide its management. Furthermore, recent data has questioned the current guidelines recommending a combined approach of antifungal agents with surgical valve or indwelling prostheses removal. With the emergence of multidrug-resistant Candida auris, a focus on improved prophylactic measures and management strategies is necessary.
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Affiliation(s)
- Yasser Jamil
- Department of Internal Medicine, Yale School of Medicine, Waterbury, CT 06708, United States.
| | - Akintayo Akinleye
- Department of Internal Medicine, Yale School of Medicine, Waterbury, CT 06708, United States
| | - Mojtaba Mirzaei
- Department of Internal Medicine, Yale School of Medicine, Waterbury, CT 06708, United States
| | - Matthew Lempel
- Department of Rheumatology, Yale School of Medicine, New Haven, CT 06510, United States
| | - Kassem Farhat
- Department of Internal Medicine, Yale School of Medicine, Waterbury, CT 06708, United States
| | - Samuel Pan
- Department of Infectious Disease, Yale School of Medicine, Waterbury, CT 06708, United States
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Khan A, Ehtesham M, Asif H, Riasat M, Alsheikhly K. Successful Debulking of Tricuspid Valve Vegetation Using Suction Filtration and Veno-Venous Bypass. Cureus 2022; 14:e22741. [PMID: 35386476 PMCID: PMC8970320 DOI: 10.7759/cureus.22741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2022] [Indexed: 11/20/2022] Open
Abstract
Tricuspid valve endocarditis with recurrent septic pulmonary emboli is an indication for surgery. In this report, we present a case of right-sided infective endocarditis (RSIE) in a female patient with a history of intravenous drug use (IVDU). The patient was admitted with multiple chief complaints of fatigue, chills, fever, cough, chest pain, and shortness of breath. She was found to have a large 1.8 cm (W) x 2.4 cm (L) mobile tricuspid valve vegetation on transthoracic echocardiogram (TTE). Despite being on appropriate antibiotics, the patient failed to improve clinically. Cardiothoracic surgery (CTS) evaluated the patient for surgical management of infective endocarditis (IE) given the size of vegetation, persistent bacteremia, and clinical deterioration. However, the risk/benefit ratio for open-heart surgery was high, given the history of active IVDU and hemodynamic instability. The patient underwent percutaneous extraction of the vegetation using suction filtration and veno-venous bypass and her condition significantly improved clinically afterward. We discuss the importance of suction filtration and veno-venous bypass in managing tricuspid valve endocarditis as an alternative in patients who are not ideal candidates for surgery and the need for more evidence regarding its effectiveness compared to surgery.
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Abstract
Serratia marcescens bacteremia is common in patient populations with a history of intravenous drug use (IVDU), but it rarely causes infective endocarditis. We are reporting a 27-year-old female with a medical history significant for IVDU and hepatitis C virus infection who presented to the emergency department complaining of fever and shortness of breath. Computed tomography of the chest with intravenous (IV) contrast revealed extensive bilateral pulmonary infiltrates with multiple cavitary lesions. The patient was treated with IV vancomycin and piperacillin/tazobactam. Blood culture grows methicillin-sensitive Staphylococcus aureus (MSSA) and S. marcescens, both sensitive to cefepime/meropenem. Transesophageal echocardiogram revealed 3.4 x 2 cm tricuspid valve vegetation. Cardiothoracic surgery was consulted, who recommended transcatheter aspiration with the AngioVac® system (AngioDynamics Inc., Latham, NY). Post-procedure transesophageal echocardiogram revealed a significant reduction of vegetation size. Vegetation tissue culture grew MSSA and S. marcescens. The repeated blood culture revealed no growth, and the patient significantly improved clinically. She completed a six-week course of IV meropenem as an inpatient until she was discharged home.
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Affiliation(s)
- Sean M Winkle
- Internal Medicine, LewisGale Medical Center, Salem, USA
| | - Salem Gaballa
- Internal Medicine, LewisGale Medical Center, Salem, USA
| | - Areeka Memon
- Osteopathic Medicine, Edward Via College of Osteopathic Medicine, Blacksburg, USA
| | | | - Ryan Curfiss
- Internal Medicine, LewisGale Medical Center, Salem, USA
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Abstract
Compared with the extensive data on left-sided infective endocarditis (IE), there is much less published information on the features and management of right-sided IE. Right-sided IE accounts for 5% to 10% of all IE cases, and compared with left-sided IE, it is more often associated with intravenous drug use, intracardiac devices, and central venous catheters, all of which has become more prevalent over the past 20 years. In this manuscript on right-sided IE we provide an up-to-date overview on the epidemiology, etiology, microbiology, potential locations of infection in the right heart, diagnosis, imaging, common complications, management, and prognosis. We present updated information on the treatment of pacemaker and device infections, infected fibrin sheaths that appear to be an easily missed source of infection after central line as well as pacemaker removal. We review current data on the AngioVac percutaneous aspiration device, which can obviate the need for surgery in patients with infected pacemaker leads and fibrin sheaths. We also focused on advanced diagnostic modalities, such as positron emission tomography/computed tomography. All of these are supported by specific case examples with detailed echocardiographic imaging from our experience.
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Affiliation(s)
- Hezzy Shmueli
- Smidt Heart Institute Cedars-Sinai Medical Center Los Angeles CA
| | - Felix Thomas
- Smidt Heart Institute Cedars-Sinai Medical Center Los Angeles CA
| | - Nir Flint
- Smidt Heart Institute Cedars-Sinai Medical Center Los Angeles CA.,Department of Cardiology Tel Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Gayatri Setia
- Smidt Heart Institute Cedars-Sinai Medical Center Los Angeles CA
| | | | - Robert J Siegel
- Smidt Heart Institute Cedars-Sinai Medical Center Los Angeles CA
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Affiliation(s)
- Christoph T Starck
- Department of Cardiothoracic & Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,German Center of Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany.,Steinbeis University Berlin, Institute (STI) of Cardiovascular Perfusion, Berlin, Germany
| | - Thomas Dreizler
- Department of Cardiothoracic & Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic & Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,German Center of Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany.,Clinic of Cardiac Surgery, University Hospital Charité Berlin, Berlin, Germany
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6
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Bauer BK, Schulze AB, Löher A, Reinke F, Eckardt L. Candida tropicalis defibrillator endocarditis: A case report and review of current literature. Med Mycol Case Rep 2019; 25:1-9. [PMID: 31245269 DOI: 10.1016/j.mmcr.2019.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 04/29/2019] [Accepted: 06/07/2019] [Indexed: 11/20/2022] Open
Abstract
We provide a review of current literature and report on a case of electronic device infective endocarditis with C. tropicalis. A 64-year-old man presented for revision of his implantable cardioverter defibrillator. Echocardiography revealed extensive vegetations attached to the Eustachian valve and in the right ventricular apex. Microbiological findings presented C. tropicalis on the explanted material. The patient refused additional surgical intervention. We successfully treated the patient with liposomal Amphotericin B and Flucytosine for 8 weeks.
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Ugwu J, Hussein U, Alliu S, Gurujal R. Percutaneous Aspiration of a Mobile Infected Thrombus from the Right Ventricular Outflow Tract Using the AngioVac System. Case Rep Cardiol 2019; 2019:6279019. [PMID: 31149364 DOI: 10.1155/2019/6279019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 04/01/2019] [Indexed: 11/30/2022] Open
Abstract
The AngioVac system was invented in 2012 and was originally designed for the removal of thrombi from the venous system. It has been successfully used in the management of iliocaval and right endocardial thrombi but is reportedly less effective in the management of pulmonary emboli (PE). Since its advent, there has been interest in its application towards other medical situations. One of the most revolutionary uses thus far has been for percutaneous debridement of valvular and cardiac electronic device-associated vegetations. In most instances, the AngioVac device has been used to obviate the need for surgery in high-risk patients. Here, we describe a novel use of this device in the successful retrieval of a large, mobile, infected thrombus from the right ventricular outflow tract in a high surgical-risk patient.
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Karasahin O, Yildiz Z, Unal O, Arslan U. A rare cause of healthcare-associated infective endocarditis: Enterobacter cloacae. IDCases 2018; 12:18-20. [PMID: 29560314 PMCID: PMC5857739 DOI: 10.1016/j.idcr.2018.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 03/03/2018] [Accepted: 03/03/2018] [Indexed: 11/27/2022] Open
Abstract
We report a case of infective endocarditis secondary to healthcare-associated bloodstream infection caused by an uncommon etiologic agent, multidrug-resistant Enterobacter cloacae. The patient was treated with a combination of antimicrobial therapy and surgery, but could not be saved. With this case, we discuss the prevalence, risk factors, treatment options, and outcomes of the rarely encountered Enterobacter cloacae-associated infective endocarditis.
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Affiliation(s)
- Omer Karasahin
- Erzurum Regional Education and Research Hospital, Erzurum, Turkey
| | - Zıya Yildiz
- Erzurum Regional Education and Research Hospital, Erzurum, Turkey
| | - Onur Unal
- Erzurum Regional Education and Research Hospital, Erzurum, Turkey
| | - Umit Arslan
- Erzurum Regional Education and Research Hospital, Erzurum, Turkey
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Michelson CM, Dyke CM, Wick DJ, Guenther R, Dangerfield D, Wiisanen ME. Use of a Modified Cardiopulmonary Bypass Circuit for Suction Embolectomy with the AngioVac Device. J Extra Corpor Technol 2017; 49:299-303. [PMID: 29302121 PMCID: PMC5737428] [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] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 07/16/2017] [Indexed: 06/07/2023]
Abstract
The AngioVac suction cannula and circuit were designed for the percutaneous removal of soft thrombus and emboli in procedures requiring extracorporeal circulatory support. We describe a modification of the AngioVac suction catheter and cardiopulmonary bypass (CPB) circuit to effectively remove thrombus while maintaining the ability to rapidly initiate full CPBs during a medical crisis. This article will discuss the design concepts of the modified circuit as well as procedural protocols and considerations. The design modifications of incorporating an oxygenator, reservoir, and bridge allow for an increased flexibility that allows adaption to veno-venous extracorporeal membrane oxygenation or full CPB support when required for oxygenation or hemodynamic support.
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Affiliation(s)
- Cara M Michelson
- University of North Dakota School of Medicine and Health Sciences, Sanford Health Fargo, Fargo, North Dakota
| | - Cornelius M Dyke
- University of North Dakota School of Medicine and Health Sciences, Sanford Health Fargo, Fargo, North Dakota
| | - Douglas J Wick
- University of North Dakota School of Medicine and Health Sciences, Sanford Health Fargo, Fargo, North Dakota
| | - Rory Guenther
- University of North Dakota School of Medicine and Health Sciences, Sanford Health Fargo, Fargo, North Dakota
| | - Dylan Dangerfield
- University of North Dakota School of Medicine and Health Sciences, Sanford Health Fargo, Fargo, North Dakota
| | - Matthew E Wiisanen
- University of North Dakota School of Medicine and Health Sciences, Sanford Health Fargo, Fargo, North Dakota
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Abubakar H, Rashed A, Subahi A, Yassin AS, Shokr M, Elder M. AngioVac System Used for Vegetation Debulking in a Patient with Tricuspid Valve Endocarditis: A Case Report and Review of the Literature. Case Rep Cardiol 2017; 2017:1923505. [PMID: 29238620 DOI: 10.1155/2017/1923505] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 10/03/2017] [Indexed: 12/21/2022] Open
Abstract
AngioVac is a vacuum-based device approved in 2014 for percutaneous removal of undesirable materials from the intravascular system. Although numerous reports exist with regard to the use of the AngioVac device in aspiration of iliocaval, pulmonary, upper extremity, and right-sided heart chamber thrombi, very few data are present demonstrating its use in treatment of right-sided endocarditis. In this case report, we describe the novel device used in debulking a large right-sided tricuspid valve vegetation reducing the occurrence of septic embolisation and enhancing the efficacy of antibiotics in clearance of bloodstream infection. Further research is needed in larger RSIE patient populations to confirm the benefits and the potential of improved outcomes associated with the AngioVac device as well as identify its potential complications.
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Erben Y, Mena-Hurtado C, Bonde P. "Raking-in Technique:" Removal Of Brachiocephalic Vein Thrombus Using AngioVac ® Device Within A Stented Venous Segment. EJVES Short Rep 2016; 32:21-23. [PMID: 28856311 PMCID: PMC5576011 DOI: 10.1016/j.ejvssr.2016.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 06/28/2016] [Accepted: 07/03/2016] [Indexed: 12/31/2022] Open
Abstract
Introduction A case is reported of left brachiocephalic vein thrombus removal using the Angiovac device within a stented venous segment via a through-and-through access technique. Report This novel technique involves obtaining through-and-through access from the left basilic vein to the right femoral vein, which then facilitates the advancement of the Angiovac device to successfully remove in a stepwise fashion the thrombus present within a stented region of the left brachiocephalic vein. Discussion The Angiovac device has been shown to be very useful and effective at removing large amounts of thrombus, tumor, and foreign bodies within arterial and venous systems successfully. This novel technique uses the through-and-through venous access approach to allow for this device to remain close to the targeted area of thrombus burden and prevent damage of the already existing stents in this region. Novel technique to extract thrombus in a stented segment of vessel. Through-and-through access technique from the left basilica vein to the right femoral vein. Central venous thrombectomy using angioplasty balloon.
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Affiliation(s)
- Y Erben
- Section of Vascular and Endovascular Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - C Mena-Hurtado
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - P Bonde
- Section of Cardiac Surgery, Yale University School of Medicine, New Haven, CT, USA
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