ABSTRACT
A 37-year-old lady with infective endocarditis of the mitral valve presented in congestive cardiac failure. However, the clinical scenario became complicated when she was also found to have antiphospholipid antibody syndrome. Meticulous optimization and timely surgical intervention by a multidisciplinary team helped mitigate this not so common situation and lead to successful outcome.
Subject(s)
Antiphospholipid Syndrome , Mitral Valve , Humans , Antiphospholipid Syndrome/complications , Antiphospholipid Syndrome/diagnosis , Female , Adult , Treatment Outcome , Mitral Valve/surgery , Mitral Valve/diagnostic imaging , Mitral Valve/microbiology , Heart Failure/etiology , Heart Failure/surgery , Heart Valve Prosthesis Implantation , Endocarditis/surgery , Endocarditis/microbiology , Endocarditis/complications , Endocarditis/diagnostic imaging , Endocarditis/diagnosis , Endocarditis, Bacterial/microbiology , Endocarditis, Bacterial/surgery , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/complications , Endocarditis, Bacterial/drug therapy , Endocarditis, Bacterial/diagnostic imaging , Anticoagulants/therapeutic useABSTRACT
INTRODUCTION: This study analyzes the outcome of a protocol-based surgical approach for ventricular septal rupture (VSR). The study also clarifies the appropriate time for intervention. METHODS: This is a single-center retrospective analysis of all VSR cases evaluated between February 2006 and March 2020. Cases were managed using the same protocol. Patients were divided into two cohorts - early (those in whom our protocol was instituted within 24 hours of diagnosis) and delayed (intervention between 24 hours and seven days after diagnosis). All-cause mortality was considered as the outcome. RESULTS: The mean age of presentation was 60.1 years, and 75.9% of the patients were men. Cardiogenic shock was the most common mode of presentation. Our analysis validates that once a patient develops VSR, age, sex, comorbidities, left ventricular function, and renal failure at the time of presentation do not have a statistically significant impact on the outcome. The sole factor to have an impact on the outcome was time of intervention. All patients in the delayed cohort expired after surgery, which dragged the overall mortality to 34.5%, whereas 95% of patients in the early cohort are still on follow-up. The mortality in this group was 5% (P≤0.001). CONCLUSION: Early surgical intervention has proven benefits over delayed approach. Surgical intervention in the early part of the disease reduces the risk and thus improves the outcome. The extreme rarity makes VSR an uncommon entity among surgeons. A protocol-based approach makes the team adapt to this unfamiliar situation better.
Subject(s)
Cardiac Surgical Procedures , Ventricular Septal Rupture , Male , Humans , Middle Aged , Female , Treatment Outcome , Retrospective Studies , Ventricular Septal Rupture/surgery , Ventricular Septal Rupture/diagnosis , Ventricular Septal Rupture/etiology , Shock, Cardiogenic/etiology , Cardiac Surgical Procedures/adverse effectsABSTRACT
ABSTRACT Introduction: This study analyzes the outcome of a protocol-based surgical approach for ventricular septal rupture (VSR). The study also clarifies the appropriate time for intervention. Methods: This is a single-center retrospective analysis of all VSR cases evaluated between February 2006 and March 2020. Cases were managed using the same protocol. Patients were divided into two cohorts - early (those in whom our protocol was instituted within 24 hours of diagnosis) and delayed (intervention between 24 hours and seven days after diagnosis). All-cause mortality was considered as the outcome. Results: The mean age of presentation was 60.1 years, and 75.9% of the patients were men. Cardiogenic shock was the most common mode of presentation. Our analysis validates that once a patient develops VSR, age, sex, comorbidities, left ventricular function, and renal failure at the time of presentation do not have a statistically significant impact on the outcome. The sole factor to have an impact on the outcome was time of intervention. All patients in the delayed cohort expired after surgery, which dragged the overall mortality to 34.5%, whereas 95% of patients in the early cohort are still on follow-up. The mortality in this group was 5% (P≤0.001). Conclusion: Early surgical intervention has proven benefits over delayed approach. Surgical intervention in the early part of the disease reduces the risk and thus improves the outcome. The extreme rarity makes VSR an uncommon entity among surgeons. A protocol-based approach makes the team adapt to this unfamiliar situation better.
ABSTRACT
Infective endocarditis (IE) complicating pregnancy though rare is associated with adverse maternal and fetal outcome. Due to its rarity and varied presentation, literature on IE complicating pregnancy is sparse. We report a case of IE complicating pregnancy caused by methicillin-resistant Staphylococcus aureus (MRSA) in a healthy pregnant lady without any known risk factors. This is the first documented case of IE complicating pregnancy without any underlying risk factors from the Indian subcontinent. This article also briefly outlines the current recommendation regarding management of infective endocarditis caused by MRSA.
