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1.
J Card Surg ; 37(9): 2845-2848, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-1971110

ABSTRACT

BACKGROUND: Candida Parapsilosis is an unusual agent of prosthetic endocarditis in immunocompetent individuals but Coronavirus disease 2019 is reported to be associated with a transient immunodeficency that exposes patientes to opportunistic infections. CASE REPORT: We describe a dreadful case of Candida Parapsilosis endocarditis in a transient immunosuppressed patient recently infected with severe acute respiratory syndrome-Coronavirus 2019. CONCLUSION: Considering that the symptoms of Candida Parapsilosis infection and the symptoms of Coronavirus disease-2019 may overlap, it is important never to understimate the non-specific symptoms to improve patient outcome, especially in patient with previous Coronavirurs disease-2019 infection and with prosthetic material grafting.


Subject(s)
COVID-19 , Candidiasis , Endocarditis , Heart Valve Prosthesis , Abscess/etiology , Abscess/surgery , Candidiasis/etiology , Endocarditis/complications , Endocarditis/surgery , Heart Valve Prosthesis/adverse effects , Humans , Risk Factors , SARS-CoV-2
6.
Monaldi Arch Chest Dis ; 92(2)2021 Dec 03.
Article in English | MEDLINE | ID: covidwho-1556232

ABSTRACT

Stuck valve is a very rare and severe complication that occurs in mechanical valve replacement patients with ineffective anticoagulation. However, with COVID-19 restriction measures, it became challenging to regularly assess INR to make sure it falls within the target therapeutic range to prevent this complication. We present a series of 10 patients who either underwent transthoracic echocardiography for a suspected stuck valve or were seen at the outpatient valve clinic with the residual consequences of a stuck valve during the COVID-19 restriction measures in our institute. Stuck prosthetic valves incident has increased significantly during this period, particularly those in the mitral position for which urgent replacement and prolonged hospitalization were necessary. Particularly with the COVID-19 restrictions in place, these cases highlight the need for physicians to be aware of the dramatic increase in the incidence of stuck prosthetic valves in patients on chronic warfarin therapy.


Subject(s)
COVID-19 , Heart Valve Prosthesis Implantation , Heart Valve Prosthesis , Anticoagulants/therapeutic use , Echocardiography , Heart Valve Prosthesis/adverse effects , Humans , Incidence
7.
Am Heart J ; 243: 77-86, 2022 01.
Article in English | MEDLINE | ID: covidwho-1536405

ABSTRACT

BACKGROUND: Regulatory agencies have endorsed more limited approaches to clinical trial site monitoring. However, the impact of different monitoring strategies on trial conduct and outcomes is unclear. METHODS: We conducted a patient-level block-randomized controlled trial evaluating the effect of intensive versus limited monitoring on cardiovascular clinical trial conduct and outcomes nested within the CoreValve Continued Access and Expanded Use Studies. Intensive monitoring included complete source data verification of all critical datapoints whereas limited monitoring included automated data checks only. This study's endpoints included clinical trial outcome ascertainment as well as monitoring action items, protocol deviations, and adverse event ascertainment. RESULTS: A total of 2,708 patients underwent transcatheter aortic valve replacement (TAVR) and were randomized to either intensive monitoring (n = 1,354) or limited monitoring (n = 1,354). Monitoring action items were more common with intensive monitoring (52% vs 15%; P < .001), but there was no difference in the percentage of patients with any protocol deviation (91.6% vs 90.4%; P = .314). The reported incidence of trial outcomes between intensive and limited monitoring was similar for mortality (30 days: 4.8% vs 5.5%, P = .442; 1 year: 20.3% vs 21.3%, P = .473) and stroke (30 days: 2.8% vs 2.4%, P = .458), as well as most secondary trial outcomes with the exception of bleeding (intensive: 36.3% vs limited: 32.0% at 30 days, P = .019). There was a higher reported incidence of cardiac adverse events reported in the intensive monitoring group at 1 year (76.7% vs 72.4%; P = .019). CONCLUSIONS: Tailored limited monitoring strategies can be implemented without influencing the integrity of TAVR trial outcomes.


Subject(s)
Aortic Valve Stenosis , Heart Valve Prosthesis , Stroke , Transcatheter Aortic Valve Replacement , Aortic Valve/surgery , Heart Valve Prosthesis/adverse effects , Humans , Incidence , Risk Factors , Stroke/epidemiology , Stroke/etiology , Stroke/prevention & control , Transcatheter Aortic Valve Replacement/methods , Treatment Outcome
9.
PLoS One ; 16(10): e0258963, 2021.
Article in English | MEDLINE | ID: covidwho-1496521

ABSTRACT

OBJECTIVE: Transcatheter aortic valve implantation (TAVI) provokes early injury response, represented in part by dynamic changes in the inflammatory markers. The association of self-expanding valves (SEVs) and balloon-expandable valves (BEVs) with the consequent inflammatory response remains uncertain. MATERIALS AND METHODS: Patients with severe symptomatic aortic stenosis who underwent transfemoral TAVI: SEVs or BEVs, from January 2010 to December 2019 were enrolled. Whole white blood cells (WBC) and subpopulation dynamics as well the neutrophil to lymphocyte ratio (NLR) were evaluated. RESULTS: Three-hundred seventy consecutive patients (mean age 81.75 ± 6.8 years, 199 women's) were enrolled. In the entire population, significant kinetic changes in the WBC response (p <0.0001) between admission and first 24 hours post procedure, with a significant increase in total WBC (7.46 ± 2.26 to 10.08 ± 3.55) and absolute neutrophil count (4.97 ± 2.06 to 8.19 ± 3.43), NL ratio (3.72 ± 2.8 to 9.76 ± 7.29), and a meaningful decrease in absolute lymphocytes count (1.67 ± 1.1 to 1.1 ± 0.76). When compared between the types of valves, SEVs were associated with a more pronounced inflammatory response than BEVs, with total WBC (10.44 ± 3.86 vs. 9.45 ± 3.19) neutrophils (8.56 ± 3.75 vs. 7.55 ± 3.06) with p 0.016 and 0.012 respectively. CONCLUSION: This is the first description of a differential inflammatory response between the two leading delivery systems. SEV appears to trigger a more robust inflammatory response as compared to BEV. Clinical studies are warranted to assess the long term effect of our findings.


Subject(s)
Aortic Valve Stenosis/surgery , Heart Valve Prosthesis , Inflammation/etiology , Transcatheter Aortic Valve Replacement/adverse effects , Aged , Aged, 80 and over , Aortic Valve Stenosis/blood , Female , Humans , Inflammation/blood , Lymphocytes , Male , Neutrophils , Postoperative Complications/blood , Postoperative Complications/etiology , Treatment Outcome
10.
BMJ Case Rep ; 14(7)2021 Jul 29.
Article in English | MEDLINE | ID: covidwho-1334545

ABSTRACT

A 29-year-old man with a history of congenital aortic stenosis and mechanical aortic valve replacement with previous Cutibacterium acnes prosthetic valve endocarditis (PVE) presented with a 2-week history of fevers and night sweats. Transoesophageal echocardiogram revealed a 0.6 cm×0.5 cm vegetation on the mechanical aortic valve. An anaerobic blood culture became positive for C. acnes 6 days after the blood cultures were obtained. He did not have any surgical intervention. He was successfully treated with 6 weeks of ceftriaxone, followed by chronic suppression with oral doxycycline. Despite its low virulence, a growing number of C. acnes PVE cases have been reported, owing to its biofilm production. When clinical suspicion is high, extending culture incubation duration beyond the standard 5 days might be helpful. Most cases are treated with surgical repair or replacement in conjunction with antibiotics, but medical therapy alone has been documented as being successful.


Subject(s)
Endocarditis, Bacterial , Endocarditis , Heart Valve Prosthesis , Prosthesis-Related Infections , Adult , Aortic Valve , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/drug therapy , Heart Valve Prosthesis/adverse effects , Humans , Male , Propionibacterium acnes , Prosthesis-Related Infections/diagnosis , Prosthesis-Related Infections/drug therapy
12.
Clin Appl Thromb Hemost ; 27: 10760296211021495, 2021.
Article in English | MEDLINE | ID: covidwho-1277870

ABSTRACT

The treatment process of patients using warfarin is expected to be hindered during the COVID-19 pandemic. Therefore we investigated whether the time in therapeutic range (TTR) and bleeding complications were affected during the COVID-19 pandemic. 355 patients using warfarin were included between March 2019 to March 2021. Demographic parameters, INR (international normalized ratio), and bleeding rates were recorded retrospectively. The TTR value was calculated using Rosendaal's method. The mean age of the patients was 61 ± 12 years and 55% of them were female. The mean TTR value during the COVID-19 pandemic was lower than the pre-COVID-19 period (56 ± 21 vs 68 ± 21, P < 0.001). Among the patients, 41% had a lack of outpatient INR control. During the COVID-19 pandemic, 71 (20%) patients using VKA suffered bleeding. Among patients with bleeding, approximately 60% did not seek medical help and 6% of patients performed self-reduction of the VKA dose. During the COVID-19 pandemic, TTR values have decreased with the lack of monitoring. Furthermore, the majority of patients did not seek medical help even in case of bleeding.


Subject(s)
Anticoagulants/pharmacology , Bleeding Time , Blood Coagulation/drug effects , COVID-19/blood , Hemorrhage/chemically induced , International Normalized Ratio , Pandemics , SARS-CoV-2 , Thrombophilia/blood , Warfarin/pharmacology , Aged , Anticoagulants/administration & dosage , Anticoagulants/adverse effects , Anticoagulants/therapeutic use , Atrial Fibrillation/complications , Atrial Fibrillation/drug therapy , COVID-19/complications , Dose-Response Relationship, Drug , Female , Heart Valve Prosthesis/adverse effects , Hemorrhage/psychology , Humans , Hypertension/complications , Male , Medication Adherence , Middle Aged , Patient Acceptance of Health Care , Pulmonary Embolism/drug therapy , Retrospective Studies , Self Medication , Thrombophilia/drug therapy , Thrombophilia/etiology , Warfarin/administration & dosage , Warfarin/adverse effects , Warfarin/therapeutic use
13.
Cardiol Young ; 31(12): 2045-2047, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1258530

ABSTRACT

Pulmonary valve endocarditis after transcatheter pulmonary valve implantation has been an emerging concern due to the increasing prevalence of transcatheter placement of pulmonary valve in the treatment of residual right ventricular outflow tract stenosis or regurgitation. Pulmonary valve endocarditis is a dreadful complication of transcatheter pulmonary valve implantation that have been reported with Melody valve (Medtronic, Inc., Minneapolis, MN) and Edward Sapien valve (Edwards Life Sciences, Irvine, CA) till date. There are scanty available literatures for pulmonary valve endocarditis with Venus P valve (Venus Medtech, Hangzhou, China) implantation. Furthermore, cardiovascular comorbidity is common in COVID-19 infection with limited evidence of COVID-19 infection concomitant with infective endocarditis. This case happens to be the first reported case of infective endocarditis of pulmonary valve with concomitant COVID-19 infection and also delayed presentation of pulmonary valve endocarditis with Venus P valve implantation.


Subject(s)
COVID-19 , Endocarditis , Heart Valve Prosthesis Implantation , Heart Valve Prosthesis , Pulmonary Valve Insufficiency , Pulmonary Valve , Cardiac Catheterization , Endocarditis/diagnosis , Endocarditis/etiology , Endocarditis/surgery , Heart Valve Prosthesis/adverse effects , Heart Valve Prosthesis Implantation/adverse effects , Humans , Prosthesis Design , Pulmonary Valve/diagnostic imaging , Pulmonary Valve/surgery , Pulmonary Valve Insufficiency/etiology , Pulmonary Valve Insufficiency/surgery , SARS-CoV-2 , Treatment Outcome
15.
J Investig Med High Impact Case Rep ; 8: 2324709620963567, 2020.
Article in English | MEDLINE | ID: covidwho-1223701

ABSTRACT

The incidence of mechanical valve thrombosis (MVT) is around 0.4 per 100 patient-years. Mitral valve thrombosis has a higher incidence than aortic valve thrombosis with a nearly 5-fold increase. Various factors contribute to MVT. The most common cause of valve thrombosis is poor adherence/disruption of anticoagulation therapy. Low cardiac output is known to increase the risk of prosthetic valve thrombosis. Other factors such as diabetes, hypertension, and other patient comorbidities might also play a role. Decreased flow promotes hypercoagulability. Lower pressure in the left atrium (and higher velocities in the left ventricle) can partially contribute to the higher incidence of mitral MVT versus aortic MVT. The presenting symptoms usually depend on the severity of the valve thrombosis; nonobstructive valve thrombosis patients have progressive dyspnea, signs of heart failure, and systemic embolization with strokes being the most common complication. In this article, we present a case of a middle-aged woman with a history of mitral and aortic mechanical prosthesis who presented with an ST-segment elevation myocardial infarction and pulmonary edema due to mechanical aortic valve prosthesis thrombosis. She had an isolated mechanical aortic valve prosthesis thrombosis with intact mitral valve, which, to the best of our knowledge, has not yet been described. We performed a literature review by searching PubMed and Embase using the keywords "mechanical valve," "thrombosis," "aortic," and "mitral," our search did not show similar cases.


Subject(s)
Aortic Valve , Heart Valve Prosthesis/adverse effects , Mitral Valve , ST Elevation Myocardial Infarction/etiology , Thrombosis/drug therapy , Cardiac Output, Low , Coronary Angiography , Echocardiography , Female , Fibrinolytic Agents/therapeutic use , Humans , Middle Aged , Platelet Aggregation Inhibitors/therapeutic use , Pulmonary Edema/diagnosis , Pulmonary Edema/drug therapy , ST Elevation Myocardial Infarction/drug therapy , Thrombosis/diagnosis
17.
Cardiovasc Revasc Med ; 28S: 68-71, 2021 07.
Article in English | MEDLINE | ID: covidwho-1176553

ABSTRACT

In 2020, the coronavirus disease 2019 (COVID-19) pandemic has led to a decrease in interventional treatment for structural heart disease worldwide. In this context, the management of patients with symptomatic severe aortic stenosis (AS) or bioprosthetic valve dysfunction (BVD) represents a clinical challenge, as a delay in aortic valve replacement procedures may increase short-term morbidity and mortality. We report four cases of TAVR performed in patients with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection. All of them were discharged in good clinical conditions and no adverse events were reported at 30 days follow-up. Our experience suggests that in selected patients with mild SARS-CoV-2 infection and symptomatic native AS or BVD, TAVR has a favorable short-term outcome.


Subject(s)
Aortic Valve Stenosis , COVID-19 , Heart Valve Prosthesis , Transcatheter Aortic Valve Replacement , Aortic Valve/diagnostic imaging , Aortic Valve/surgery , Aortic Valve Stenosis/diagnostic imaging , Aortic Valve Stenosis/surgery , Feasibility Studies , Humans , Risk Factors , SARS-CoV-2 , Transcatheter Aortic Valve Replacement/adverse effects , Treatment Outcome
18.
Open Heart ; 8(1)2021 03.
Article in English | MEDLINE | ID: covidwho-1153699

ABSTRACT

Transcatheter aortic valve implantation (TAVI) is a proven treatment for life-threatening aortic valve disease, predominantly severe aortic stenosis. However, even among developed nations, access to TAVI is not uniform. The Valve for Life initiative was launched by the European Association of Percutaneous Cardiovascular Interventions in 2015 with the objective of improving access to transcatheter valve interventions across Europe. The UK has been identified as a country with low penetration of these procedures and has been selected as the fourth nation to be included in the initiative. Specifically, the number of TAVI procedures carried out in the UK is significantly lower than almost all other European nations. Furthermore, there is substantial geographical inequity in access to TAVI within the UK. As a consequence of this underprovision, waiting times for TAVI are long, and mortality among those waiting intervention is significant. This article reviews these issues, reports new data on access to TAVI in the UK and presents the proposals of the UK Valve for Life team to address the current problems in association with the British Cardiovascular Intervention Society.


Subject(s)
Aortic Valve Stenosis/surgery , Aortic Valve/surgery , Heart Valve Prosthesis , Transcatheter Aortic Valve Replacement/methods , Aortic Valve Stenosis/epidemiology , Humans , Incidence , Risk Factors , United Kingdom
20.
Echocardiography ; 38(5): 798-804, 2021 05.
Article in English | MEDLINE | ID: covidwho-1132888

ABSTRACT

The COVID-19 pandemic has presented countless new challenges for healthcare providers including the challenge of differentiating COVID-19 infection from other diseases. COVID-19 infection and acute endocarditis may present similarly, both with shortness of breath and vital sign abnormalities, yet they require very different treatments. Here, we present two cases in which life-threatening acute endocarditis was initially misdiagnosed as COVID-19 infection during the height of the pandemic in New York City. The first was a case of Klebsiella pneumoniae mitral valve endocarditis leading to papillary muscle rupture and severe mitral regurgitation, and the second a case of Streptococcus mitis aortic valve endocarditis with heart failure due to severe aortic regurgitation. These cases highlight the importance of careful clinical reasoning and demonstrate how cognitive errors may impact clinical reasoning. They also underscore the limitations of real-time reverse transcription-polymerase chain reaction (RT-PCR) for SARS-CoV-2 testing and illustrate the ways in which difficulty interpreting results may also influence clinical reasoning. Accurate diagnosis of acute endocarditis is critical given that surgical intervention can be lifesaving in unstable patients.


Subject(s)
COVID-19 , Endocarditis, Bacterial , Endocarditis , Heart Valve Prosthesis , Aortic Valve , COVID-19 Testing , Diagnostic Errors , Endocarditis, Bacterial/diagnosis , Humans , Pandemics , SARS-CoV-2
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