Echocardiographic findings in patent ductus arteriosus-associated infective endarteritis.

BACKGROUND: Infectious endarteritis associated with patent ductus arteriosus (PDA-IE) is an uncommon complication in the era of antibiotics. However, it implies a clinical challenge in patients with a fever of undetermined origin; Two-dimensional transthoracic echocardiography (TTE) performs a fundamental role in diagnosis and follow-up. METHODS: A retrospective analysis was then made of the data of all patients admitted at our center with PDA-IE within 15 years, and a review of the literature regarding diagnosis, TTE findings, and treatment was performed. RESULTS: A total of 17 patients were identified. The mean age was 17.8 years. The TTE done in all patients confirmed the PDA and PA vegetations diagnosis; in five cases, one vegetation was present; in three cases, two vegetations were found, and in the nine remaining cases, three or more vegetations were observed. In two-thirds of the cases, the vegetations' size was 3 to 28 mm, and the principal morphology was filiform. In all cases, at least one of the vegetations was developed in the DA's lateral wall. Pulmonary valve (PV) was affected in 41% of the patients and caused low to moderate valvular regurgitation. Pulmonary embolism was present in 7 cases and pulmonary aneurism in one case. CONCLUSIONS: Decreased incidence of PDA-IE has been currently achieved with early antibiotic therapy. However, today, this complication carries a significant risk of valve damage and other cardiac structures' involvement.

Pulmonary endarteritis and endocarditis complicated with septic embolism: a case report and review of the literature.

BACKGROUND: Pulmonary endarteritis is a rare clinical phenomenon with congenital heart that can potentially lead to major complications. CASE PRESENTATION: We report a 47-year-old man with pulmonary endarteritis. This patient presented with hypertension, chest pain and a previous history of pulmonary valve disease during childhood. Also, eight-months prior, he was hospitalized with dyspnea (Functional Class III), cough, phlegm, and night sweats without fever. Echocardiographic diagnosis in the first transtransthoracic echocardiography (TTE) was intense pulmonary valve stenosis (PVS) an, thus, the pulmonary valve vegetation and PVS, established by transesophageal echocardiography (TEE). He was referred for surgery after 1 weeks of intravenous antibiotic therapy for removal of the vegetation. CONCLUSIONS: Finally he was asymptomatic at 3-months of follow-up and was clinically in good condition. Therefore, the detection of infective endocarditis of the lung valve must not lengthy be prolonged.

A case report on endarteritis in a child with coarctation of aorta.

Coarctation of aorta(CoA), complicated by endarteritis in a children is very rare. Here we present a case of endarteritis in an unoperated CoA in a four year old boy. CoA had been diagnosed in the referring hospital, yet the diagnosis of endocarditis distal to CoA, was made in the tertiary center using modified transthoracic echo windows or focused views. After six weeks of intravenous antibiotic treatment, a coarctectomy and end-to-end anastomosis was performed and he recovered clinically well. This case report concludes that echocardiography remains as the standard diagnostic method for identifying intracardiac manifestations of infective endocarditis/endarteritis. Last but foremost, it delineates the importance of modified transthoracic echo windows or focused views in identifying the unusual position of endocarditis.

Fungal prosthetic aortic valve endocarditis and endarteritis: An unusual cause of aortic root vegetations.

Fungal endocarditis is a relatively rare occurrence with high morbidity and mortality. Patients may have an indolent and non-specific course requiring a high index of suspicion to make a diagnosis. Here, we present the case of a 33-year-old patient who presented with fevers and acute lower limb ischemia requiring a 4-compartment fasciotomy caused by septic emboli from Candida albicans endocarditis. The patient had a large vegetation in the ascending aorta associated with a mycotic aneurysm, which is an exceedingly rare location for a vegetation. We also review the literature and summarize the typical echocardiographic appearance and vegetation locations in fungal endocarditis.

Endarteritis of coarctation of the aorta diagnosed with PET-CT.

Infective endocarditis (IE) is an infectious disease that affects the endothelium of the large intrathoracic vessels, heart valves, and intra-cardiac foreign body material. A 20-year-old woman was admitted to the cardiology department with complaints of fever and palpitations. Transthoracic echocardiography revealed a bicuspid aortic valve, aortic root enlargement, and aortic coarctation. Transesophageal echocardiography revealed a bicuspid aortic valve, but there was no vegetation. Methicillin-sensitive Staphylococcus aureus was identified on a blood culture. 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) revealed increased intensive glucose uptake on the dilated aortic segment adjacent to the distal coarctation zone. Several reports have shown promising results for radio-labelled white blood cell single-photon emission computed tomography and 18F-FDG PET-CT imaging in IE. To our knowledge, this is the first described case in which PET-CT revealed endarteritis of the descending aorta in a patient without prosthetic material.

Carotid inflammation is unaltered by exercise in hypercholesterolemic Swine.

INTRODUCTION: Reduction of vascular inflammation might contribute to the beneficial effects of exercise. We hypothesized that 1) exercise would reduce carotid endothelial vascular cell adhesion molecule-1 (VCAM-1) and that 2) in vivo detection of carotid inflammation can be achieved in a large animal model using contrast-enhanced ultrasound (CEU) with VCAM-1-targeted microbubbles (MBs). METHODS: Familial hypercholesterolemic (FH) swine were divided into sedentary (Sed) and exercise-trained (Ex) groups. Ex pigs underwent 16-20 wk of treadmill aerobic exercise. At the end of the study, in vivo CEU with VCAM-1-targeted MBs and assessment of endothelial-dependent dilation (EDD) were performed in carotid arteries. VCAM-1 mRNA and protein expression were compared with markers of atherosclerotic disease and health, and in vitro EDD was assessed in carotid arteries. RESULTS: Exercise training neither reduced inflammation nor improved EDD in carotid arteries of FH swine. Markers of atherosclerosis including VCAM-1 were prominent in the bifurcation compared with the proximal or distal common carotid artery and inversely associated with phosphorylated and total endothelial nitric oxide synthase. Signal intensity from VCAM-1-to-control MBs positively correlated with carotid VCAM-1 protein expression, validating our technique. CONCLUSION: These results first demonstrate that aerobic exercise has no effect on carotid endothelial inflammatory markers and EDD in FH swine. Second, our findings indicate that CEU using VCAM-1-targeted MBs can detect inflammation in vivo, providing strong foundations for longitudinal studies examining the effect of therapeutic interventions on the inflammatory status of the endothelium.

Aortic coarctation endarteritis in an adult: case report with cardiovascular magnetic resonance imaging findings and review of the literature.

We describe a case of coarctation endarteritis in an adult and review the literature pertaining to this condition. Adult coarctation endarteritis is a rare entity but often represents the initial presentation of coarctation. Diagnosis is critically important given the risk of rupture. Cardiovascular magnetic resonance imaging can be helpful in management.

Utility of transesophageal echocardiography in the examination of adult patients with patent ductus arteriosus.

Thirteen patients with clinical suspicion of patent ductus arteriosus were evaluated by transthoracic and transesophageal echocardiographic studies. Findings were corroborated during corrective surgery in 8 patients and by cardiac catheterization in 5. Transthoracic echocardiography confirmed the diagnosis in 7 patients; in 2 of the patients endarteritis of the pulmonary artery was demonstrated, and in one infective vegetations in aortic and mitral valves. With transesophageal echocardiography, patent ductus arteriosus was established in all 8 patients and endarteritis of the pulmonary artery was shown in 3, including 1 not discovered by transthoracic technique. In 1 of these patients, vegetations were also found on the pulmonic valve. Both techniques demonstrated significant pulmonary hypertension in 5 cases; contrast studies showed the venoarterial shunt between the pulmonary artery and the aorta with particular clarity in transesophageal images. On the basis of these findings it may be concluded that transesophageal echocardiography complements the information provided by transthoracic recordings in adult patients with patent ductus arteriosus, especially when it is associated with pulmonary hypertension or pulmonary endarteritis.

Meningovascular neurosyphilis in human immunodeficiency virus infection as a differential diagnosis of focal CNS lesions: a clinicopathological study.

The acquired immunodeficiency syndrome (AIDS) appears to alter the course of syphilis and particularly neurosyphilis. We report the case of an HIV-positive patient with two CNS lesions due to vascular complications of neurosyphilis of the meningovascular type, 18 months after he had developed a penile chancre. On admission, CT scans were inconsistent with cerebral toxoplasmosis or CNS lymphoma. At necropsy, histopathological examination showed typical Heubner's endarteritis of the basilar and posterior cerebral arteries. In AIDS patients, superadded meningovascular syphilis must be suspected, especially when CT scanning reveals the presence of multi-focal, low density lesions with the particular characteristics of infarction.

[The lymphatic system of the lower extremities in patients with obliterating diseases of the terminal portion of the aorta and its branches]. / Limfaticheskaia sistema nizhnikh konechnostei u bol'nykh s obliteriruiushchimi zabolevaniiami terminal'nogo otdela aorty i ee vetvei.

The paper deals with the results of X-ray lymphographic and morphological studies of the peripheral lymphatic system in 82 patients with various stages of chronic lower extremity arterial insufficiency. Destructive and sclerotic changes in lymphatic vessels, inguinal lymph nodes, and impairments in lymph flow whose severity was in proportion to the stage of chronic ischemia were detected. The associated immune, barrier-filtration and transport dysfunctions called for their adequate correction. In patients with Stages II and III ischemia, direct controlled endolymphatic therapy promotes the improvement of tissue lymphatic drainage and hemocirculation in the diseased extremity and recovery of immune homeostasis in the region.