Subject(s)
Aneurysm, False/microbiology , Endocarditis, Bacterial/complications , Heart Aneurysm/microbiology , Heart Rupture/microbiology , Prosthesis-Related Infections/complications , Staphylococcal Infections , Aortic Valve Insufficiency/microbiology , Echocardiography, Three-Dimensional , Echocardiography, Transesophageal , Fatal Outcome , Heart Valve Prosthesis , Humans , Male , Middle Aged , Mitral Valve , Multimodal Imaging , Staphylococcus aureusSubject(s)
Aortic Valve/microbiology , Endocarditis/microbiology , Heart Rupture/microbiology , Viridans Streptococci/isolation & purification , Anti-Bacterial Agents/therapeutic use , Aortic Valve/diagnostic imaging , Aortic Valve/pathology , Aortic Valve/surgery , Autopsy , Cardiac Surgical Procedures , Echocardiography, Doppler, Color , Echocardiography, Transesophageal , Endocarditis/diagnostic imaging , Endocarditis/pathology , Endocarditis/therapy , Fatal Outcome , Heart Rupture/diagnostic imaging , Heart Rupture/pathology , Heart Rupture/therapy , Humans , Male , Middle Aged , Treatment OutcomeSubject(s)
Cardiac Surgical Procedures/adverse effects , Heart Rupture/microbiology , Mediastinitis/microbiology , Sternotomy/adverse effects , Surgical Wound Infection/microbiology , Anti-Bacterial Agents/therapeutic use , Heart Rupture/therapy , Heart Ventricles/microbiology , Hemorrhage/microbiology , Hemostatic Techniques , Humans , Mediastinitis/diagnostic imaging , Mediastinitis/therapy , Negative-Pressure Wound Therapy , Radiography , Reoperation , Surgical Wound Dehiscence/microbiology , Surgical Wound Infection/diagnostic imaging , Surgical Wound Infection/therapy , Suture Techniques , Treatment OutcomeSubject(s)
Drainage/adverse effects , Heart Rupture/microbiology , Hemorrhage/microbiology , Mediastinitis/microbiology , Sternotomy/adverse effects , Surgical Wound Infection/microbiology , Anti-Bacterial Agents/therapeutic use , Cardiac Surgical Procedures/adverse effects , Heart Rupture/diagnostic imaging , Heart Rupture/therapy , Heart Ventricles/microbiology , Hemorrhage/diagnostic imaging , Hemorrhage/therapy , Hemostatic Techniques , Humans , Mediastinitis/diagnostic imaging , Mediastinitis/therapy , Negative-Pressure Wound Therapy , Radiography , Reoperation , Surgical Wound Dehiscence/microbiology , Surgical Wound Infection/diagnostic imaging , Surgical Wound Infection/therapy , Suture Techniques , Treatment OutcomeSubject(s)
Heart Rupture/microbiology , Hemorrhage/microbiology , Mediastinitis/microbiology , Negative-Pressure Wound Therapy/adverse effects , Sternotomy/adverse effects , Surgical Wound Infection/microbiology , Anti-Bacterial Agents/therapeutic use , Drainage , Heart Rupture/diagnostic imaging , Heart Rupture/therapy , Heart Ventricles/microbiology , Hemorrhage/diagnostic imaging , Hemorrhage/therapy , Hemostatic Techniques , Humans , Mediastinitis/diagnostic imaging , Mediastinitis/therapy , Radiography , Reoperation , Surgical Wound Dehiscence/microbiology , Surgical Wound Infection/diagnostic imaging , Surgical Wound Infection/therapy , Suture Techniques , Treatment OutcomeABSTRACT
Right ventricular (RV) rupture in cases of mediastinitis following cardiac surgery is a rare and dangerous complication. Bleeding from the right ventricle occurs mainly after sternal reopening, due to either iatrogenic manipulation (wire removal, lesions due to wiring maneuvers) or mechanical shearing forces, producing direct injury. We present a case of RV wall perforation due to infection in a recurrent postoperative mediastinitis with a closed chest. The current literature on treatment of postoperative mediastinitis is also reviewed.
Subject(s)
Heart Rupture/microbiology , Hemorrhage/microbiology , Mediastinitis/microbiology , Staphylococcal Infections/microbiology , Staphylococcus epidermidis/isolation & purification , Sternotomy/adverse effects , Surgical Wound Infection/microbiology , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Coronary Artery Bypass/adverse effects , Drainage , Heart Rupture/diagnostic imaging , Heart Rupture/therapy , Heart Ventricles/microbiology , Hemorrhage/diagnostic imaging , Hemorrhage/therapy , Hemostatic Techniques , Humans , Male , Mediastinitis/diagnostic imaging , Mediastinitis/therapy , Negative-Pressure Wound Therapy , Recurrence , Reoperation , Staphylococcal Infections/diagnostic imaging , Staphylococcal Infections/therapy , Surgical Wound Dehiscence/microbiology , Surgical Wound Infection/diagnostic imaging , Surgical Wound Infection/therapy , Suture Techniques , Tomography, X-Ray Computed , Treatment OutcomeSubject(s)
Aneurysm, Infected/surgery , Aneurysm, Ruptured/surgery , Cardiac Surgical Procedures , Heart Aneurysm/surgery , Heart Rupture/surgery , Heart-Assist Devices , Ventricular Function, Left , Adolescent , Aneurysm, Infected/complications , Aneurysm, Infected/diagnostic imaging , Aneurysm, Infected/microbiology , Aneurysm, Infected/physiopathology , Aneurysm, Ruptured/diagnostic imaging , Aneurysm, Ruptured/microbiology , Aneurysm, Ruptured/physiopathology , Echocardiography , Female , Heart Aneurysm/complications , Heart Aneurysm/diagnostic imaging , Heart Aneurysm/microbiology , Heart Aneurysm/physiopathology , Heart Rupture/diagnostic imaging , Heart Rupture/microbiology , Heart Rupture/physiopathology , Humans , Reoperation , Secondary Prevention , Staphylococcus aureus/isolation & purification , Treatment OutcomeSubject(s)
Aneurysm, False/diagnostic imaging , Heart Aneurysm/diagnostic imaging , Heart Rupture/diagnostic imaging , Shock, Septic/microbiology , Staphylococcal Infections/complications , Aneurysm, False/microbiology , Echocardiography , Heart Aneurysm/microbiology , Heart Rupture/microbiology , Heart Ventricles , Humans , Male , Middle Aged , Staphylococcal Infections/diagnostic imaging , Staphylococcus aureusSubject(s)
Mitral Valve Insufficiency/diagnostic imaging , Streptococcal Infections/diagnostic imaging , Adult , Aneurysm, Infected/diagnostic imaging , Aneurysm, Infected/microbiology , Aortic Valve Insufficiency/microbiology , Echocardiography/methods , Endocarditis, Bacterial/diagnostic imaging , Endocarditis, Bacterial/microbiology , Heart Aneurysm/diagnostic imaging , Heart Aneurysm/microbiology , Heart Rupture/diagnostic imaging , Heart Rupture/microbiology , Humans , Male , Mitral Valve Insufficiency/microbiology , Rupture, Spontaneous/diagnostic imaging , Rupture, Spontaneous/microbiology , Streptococcal Infections/complicationsABSTRACT
We undertook this study to determine the use of transthoracic and transesophageal echocardiography in detecting valvular perforation and the clinical impact of the latter on the outcome of left-sided infective endocarditis. Transthoracic echocardiography was performed in 58 consecutive patients with infective endocarditis. According to the study protocol, a subgroup of 42 patients also underwent transesophageal echocardiogrophy. At referral, 20 (34%) of 58 patients had echocardiographic evidence of valvular perforation (group A). No valvular perforations were found in the remaining 38 patients (group B). During a follow-up period of 27 +/- 16 months, a major complication occurred in 18 of 20 patients in group A and in 11 of 38 patients in group B (p < 0.0001). Univariate analysis indicated previous infective endocarditis, aortic involvement, and New York Heart Association functional class had a predictive value for valvular perforation (p < 0.001). Stepwise regression analysis confirmed aortic valve perforation as the only independent predictive variable for surgery and death. Valvular perforation is a common complication of infective endocarditis and is associated with an adverse outcome. Transthoracic echocardiography can detect or suggest valvular perforation in infective endocarditis, but transesophageal echocardiography better defines this complication and predicts severe heart failure or the need for early surgical management.
