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The patient was a 68-year-old man. In January 2017, he underwent aortic valve replacement (Carpentier-Edwards Perimount Magna, 25 mm, Edwards Lifescience Corporation, Irvine, USA) for aortic stenosis and coronary bypass surgery with two saphenous vein grafts (SVG-#7 and SVG-4PD) for asymptomatic myocardial ischemia. He was treated as an outpatient by a local physician for at least a week during November 2017, with a principal complaint of mild fever, but no other significant symptoms. Transthoracic echocardiography suggested prosthetic valve endocarditis, so he was referred to the author's hospital. The day after admission, he had symptoms of thoracic discomfort, and emergency cardiac catheter examination showed a lesion thought to be due to a thrombus in the left main coronary trunk ; so, thrombus aspiration was carried out. However, no improvement in blood flow was achieved, so balloon angioplasty was carried out, with the aim of improving blood flow in the left circumflex artery, where coronary artery bypass grafting had not been performed. Improvement in blood flow was achieved, and a culture was carried out using the aspirated thrombus. Streptococcus pasteurianus was detected in the culture.
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<p>A 23-year-old woman with mitral valve infective endocarditis complicated by embolism of the right common iliac artery underwent transfemoral embolectomy by a Fogarty catheter and mitral valve replacement. She developed occlusion of the right internal iliac artery, that was revealed by computed tomography on the 9th postoperative day. The occlusion was considered to result from migration of a part of the emboli from the right common iliac artery into the right internal iliac artery during the procedure of embolectomy. On the 16th postoperative day, she underwent repeat mitral valve replacement because of perivalvular leakage. Furthermore, after 2 weeks from the diagnosis of embolism of the right internal iliac artery, the embolic site showed aneurysmal formation finally requiring aneurysmectomy. Her recovery was uneventful. Our case is considered to be rare in that serial observations on computed tomography indicated the development of mycotic aneurysm at the site of septic embolism. In addition, care must be taken to prevent migration of emboli into branched arteries during the procedure of embolectomy for peripheral arterial septic embolism caused by infective endocarditis.</p>
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Aims: In patients with infective endocarditis, with risk of embolization, early identification of parenchymal changes may suggest the risk of splenic rupture. Presentation of Case: A 68-year-old male presented with a history of 2 months of fever and also left upper quadrant pain initiated 2 days before admission. Transesophageal echocardiogram demonstrated the presence of two mobile vegetations on the ventricular side of the aortic valve; the largest diameter being 2.1 cm. Enterococcus faecalis was isolated in blood culture after a diagnosis of subacute aortic valve infective endocarditis. He complained of abdominal pain. An abdominal computed tomography scan revealed infarction of the upper region of the spleen (septic embolism). Therapy with penicillin and gentamicin was initiated, but the patient developed symptoms of heart failure that led to a surgical treatment, and aortic bioprosthesis was implanted on day 14. On day 5 postoperatively, the patient developed sudden hemorrhagic shock signs due to splenic rupture and underwent emergency splenectomy. A pathological examination revealed areas of splenic laceration of the capsule, splenic infarction areas, and the absence of abscesses. Splenic rupture is a complication much rarely occurring due to infectious endocarditis caused by E. faecalis. Conclusion: This case highlights the importance of conducting serial imaging, particularly in symptomatic patients, for the early detection of parenchymal changes that may suggest the risk of rupture.
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Haemophilus aphrophilus is a facultatively anaerobic gram-negative bacillus and require 5 to 10 % CO2 to grow optimally. H. aphrophilus is differentiated from other members of Haemophilus species by no requirement of X or V factor. This organism is found as the normal flora in upper respiratory tract but a member of the HACEK group that cause native valve endocarditis. Since the first endocarditis of H. aphrophilus was reported at 1985 in Korea, we reported the second case. A 35-year-old male patient was admitted to Asan Medical Center because of fever for 15 days and altered mentality developed 2 days ago. His echocardiography revealed a mitral valve regurgitation with a hypermobile vegetation and multiple septic emboli were also found in the brain MRI. Three sets of blood cultures were taken on the day of admission, all of which grew pleomorphic, gram-negative bacilli at incubation day 1. Catalase and oxidase test was negative and Vitek NHI card (bioMerieux Vitek, Inc., Hazelwood Mo., USA) identified the organisms to H. aphrophilus 50%/H. paraphrophilus 49% (Bionumber 257310). It was finally identified to H. aphrophilus with requirement tests of X or V factors; it required neither X nor V factor. This H. aphrophilus strain was negative inlactamase and was susceptible to ampicillin, gentamicin, cefuroxime, imipenem, ciprofloxacin, aztreonam, azithromycin, rifampin, and trimethoprim/sulfamethoxazole. This patient was successfully treated with ampicillin and gentamicin after mitral valve replacement under diagnosis of H. aphrophilus endocarditis