RESUMEN
BACKGROUND: This case highlights several complications of a late and rare presentation of culture-negative Streptococcus pyogenes endocarditis of a previously repaired mitral valve with an annuloplasty ring including recurrent cardioembolic strokes, which was initially missed on transthoracic echocardiography. CASE PRESENTATION: A 66-year-old Caucasian female with prior mitral valve prolapse status post mitral valve annuloplasty and left atrial appendage occlusion, followed by two strokes, presented with supraventricular tachycardia that resolved spontaneously. During an inpatient admission, she developed symptoms of another stroke, and imaging studies were suggestive of recurrent cardioembolic phenomenon. Additional workup revealed two small intra-atrial masses adherent to the mitral annuloplasty ring missed on prior evaluation for recurrent stroke. She underwent surgical repair in the setting of a chronic culture-negative infectious endocarditis with Streptococcus pyogenes and recovered well with no further cardioembolic phenomenon. CONCLUSION: This case serves to highlight the importance of having a higher index of suspicion in any cardiac prosthesis patient for endocarditis when presenting with symptoms such as recurrent stroke, arrhythmias, and abnormal cardiac lab work. It also demonstrates the need for appropriate imaging with transthoracic echocardiography followed by transesophageal echocardiography and reviews surgical indications to diagnose and treat culture-negative endocarditis.
Asunto(s)
Ecocardiografía , Endocarditis Bacteriana , Infecciones Estreptocócicas , Streptococcus pyogenes , Humanos , Femenino , Anciano , Streptococcus pyogenes/aislamiento & purificación , Infecciones Estreptocócicas/diagnóstico por imagen , Endocarditis Bacteriana/diagnóstico por imagen , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/cirugía , Anuloplastia de la Válvula Mitral , Prolapso de la Válvula Mitral/cirugía , Prolapso de la Válvula Mitral/diagnóstico por imagen , Ecocardiografía Transesofágica , Válvula Mitral/cirugía , Válvula Mitral/diagnóstico por imagen , Infecciones Relacionadas con Prótesis/diagnóstico por imagen , Infecciones Relacionadas con Prótesis/microbiología , Infecciones Relacionadas con Prótesis/cirugíaRESUMEN
Definitive diagnosis of infective endocarditis (IE) is mainly based on microbiological and imaging criteria. In a minority of cases, particularly when perivalvular area is involved, cardiac conduction disorders (CCD) may appear, which implies worse prognosis. In this scenario, different degrees of auriculoventricular block can occur, but development of bundle branch block is rare. Herein, we present a case of IE with negative initial imaging tests, where the occurrence of phase 4 bundle branch block after a sequence of type I second degree AV block was crucial to establish a definitive diagnosis and an optimal therapeutic approach.
Asunto(s)
Bloqueo de Rama , Electrocardiografía , Humanos , Bloqueo de Rama/diagnóstico , Masculino , Diagnóstico Diferencial , Endocarditis/diagnóstico por imagen , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/diagnóstico por imagen , Persona de Mediana EdadRESUMEN
Heart valve replacement has steadily increased over the past decades due to improved surgical mortality, an aging population, and the increasing use of transcatheter valve technology. With these developments, prosthetic valve complications, including prosthetic valve endocarditis, are increasingly encountered. In this review, we aim to characterize the manifestations of prosthetic valve endocarditis using representative case studies from our institution to highlight the advances and contributions of modern multimodality imaging techniques.
Asunto(s)
Endocarditis Bacteriana , Endocarditis , Implantación de Prótesis de Válvulas Cardíacas , Prótesis Valvulares Cardíacas , Infecciones Relacionadas con Prótesis , Humanos , Anciano , Endocarditis Bacteriana/diagnóstico por imagen , Endocarditis Bacteriana/terapia , Prótesis Valvulares Cardíacas/efectos adversos , Endocarditis/diagnóstico por imagen , Endocarditis/etiología , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Imagen Multimodal , Infecciones Relacionadas con Prótesis/diagnóstico por imagen , Infecciones Relacionadas con Prótesis/terapiaRESUMEN
Coronary artery fistula (CAF) is characterized as a congenital or acquired abnormal communication between a coronary artery and any of the four chambers of the heart (coronary-cameral fistula) or great vessels (coronary arteriovenous fistula) bypassing the capillaries within myocardium. CAF is a rare disease, challenging to diagnose and treat depending on the anatomical location and type of the fistula and accompanying diseases. This study aims to report a case with multiple coronary artery to coronary sinus (CS) fistulas with giant left circumflex artery and multivalvular infective endocarditis.
Asunto(s)
Fístula Arteriovenosa , Enfermedad de la Arteria Coronaria , Seno Coronario , Anomalías de los Vasos Coronarios , Endocarditis Bacteriana , Endocarditis , Humanos , Seno Coronario/diagnóstico por imagen , Seno Coronario/cirugía , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Anomalías de los Vasos Coronarios/cirugía , Endocarditis Bacteriana/complicaciones , Endocarditis Bacteriana/diagnóstico por imagen , Endocarditis Bacteriana/cirugía , Enfermedad de la Arteria Coronaria/complicaciones , Endocarditis/complicaciones , Fístula Arteriovenosa/diagnóstico por imagen , Fístula Arteriovenosa/cirugíaRESUMEN
A 60-year-old man presented with breathlessness. Nearly four decades previously, he had required three operations for Staphylococcus aureus infective endocarditis of the tricuspid valve and had received a bioprosthetic valve. He had critical tricuspid bioprosthesis stenosis which was treated successfully by valve-in-valve transcatheter tricuspid valve replacement using a balloon-expandable transcatheter heart valve. One year after intervention, the patient is well with no tricuspid valve stenosis or regurgitation.
Asunto(s)
Bioprótesis , Endocarditis Bacteriana , Implantación de Prótesis de Válvulas Cardíacas , Prótesis Valvulares Cardíacas , Estenosis de la Válvula Tricúspide , Masculino , Humanos , Persona de Mediana Edad , Adulto , Bioprótesis/efectos adversos , Constricción Patológica , Válvula Tricúspide/diagnóstico por imagen , Válvula Tricúspide/cirugía , Estenosis de la Válvula Tricúspide/diagnóstico por imagen , Estenosis de la Válvula Tricúspide/cirugía , Prótesis Valvulares Cardíacas/efectos adversos , Endocarditis Bacteriana/diagnóstico por imagen , Endocarditis Bacteriana/cirugía , Resultado del Tratamiento , Diseño de Prótesis , Falla de PrótesisRESUMEN
Infective endocarditis (IE) is today a public health problem, as the recent ESC Guidelines have also recalled. Abscesses can be complications of IE and their presence means that the infection is not controlled. We describe the complex case of a 57-year-old patient, presented in ED for fever and oleocranical bursitis, increase of cardiac enymes at blood samples. He was admitted to our Cardiology Unit because TTE showed a floating peduncolated formation in the left ventricle. The susequent TEE documented also the presence of a myocardial abscess, confirmed at cardiac MRI. Blood cultures were positive for MSSA and the man received specific antibiotic therapy. Anticoagulation treatment was started with UFH and then switched to Warfarin, surgical approach of the lesion would have been too dangerous according to Cardiac Surgeons. Serious and sudden neurological complications then followed, leading the patient to brain death in ICU.
Asunto(s)
Absceso , Antibacterianos , Ecocardiografía Transesofágica , Endocarditis Bacteriana , Trombosis , Humanos , Persona de Mediana Edad , Masculino , Absceso/microbiología , Absceso/diagnóstico por imagen , Absceso/tratamiento farmacológico , Antibacterianos/uso terapéutico , Resultado del Tratamiento , Resultado Fatal , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/complicaciones , Endocarditis Bacteriana/tratamiento farmacológico , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/diagnóstico por imagen , Trombosis/diagnóstico por imagen , Trombosis/microbiología , Trombosis/etiología , Trombosis/tratamiento farmacológico , Trombosis/cirugía , Infecciones Estafilocócicas/microbiología , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/diagnóstico por imagen , Infecciones Estafilocócicas/complicaciones , Infecciones Estafilocócicas/diagnóstico , Anticoagulantes/uso terapéutico , Imagen por Resonancia MagnéticaRESUMEN
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.
Asunto(s)
Síndrome Antifosfolípido , Válvula Mitral , Humanos , Síndrome Antifosfolípido/complicaciones , Síndrome Antifosfolípido/diagnóstico , Femenino , Adulto , Resultado del Tratamiento , Válvula Mitral/cirugía , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/microbiología , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/cirugía , Implantación de Prótesis de Válvulas Cardíacas , Endocarditis/cirugía , Endocarditis/microbiología , Endocarditis/complicaciones , Endocarditis/diagnóstico por imagen , Endocarditis/diagnóstico , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/cirugía , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/complicaciones , Endocarditis Bacteriana/tratamiento farmacológico , Endocarditis Bacteriana/diagnóstico por imagen , Anticoagulantes/uso terapéuticoRESUMEN
A dog was presented for lameness, fever, and extreme lethargy. On physical exam, a new heart murmur, arrhythmia, and joint effusion were detected. These findings were not detected two months prior. A diagnostic work-up confirmed septic suppurative inflammation in multiple joints. Echocardiogram revealed aortic valvular endocarditis along with a communication, as a consequence of a fistula, that extended from just below the aortic sinotubular junction to the left atrial lumen. Due to a poor prognosis, humane euthanasia was elected. Necropsy and histopathology confirmed infective endocarditis of the aortic valve and an aorto-left atrial fistulous tract extending from the left coronary sinus of the aortic valve to the lumen of left atrium.
Asunto(s)
Enfermedades de los Perros , Ecocardiografía , Atrios Cardíacos , Animales , Perros , Enfermedades de los Perros/patología , Enfermedades de los Perros/diagnóstico por imagen , Atrios Cardíacos/patología , Atrios Cardíacos/diagnóstico por imagen , Ecocardiografía/veterinaria , Fístula/veterinaria , Fístula/diagnóstico por imagen , Endocarditis Bacteriana/veterinaria , Endocarditis Bacteriana/complicaciones , Endocarditis Bacteriana/diagnóstico por imagen , Endocarditis Bacteriana/patología , Fístula Vascular/veterinaria , Fístula Vascular/diagnóstico por imagen , Fístula Vascular/complicaciones , Masculino , Enfermedades de la Aorta/veterinaria , Enfermedades de la Aorta/diagnóstico por imagen , Enfermedades de la Aorta/patología , Enfermedades de la Aorta/complicaciones , Endocarditis/veterinaria , Endocarditis/complicaciones , Endocarditis/diagnóstico por imagen , Endocarditis/patología , Cardiopatías/veterinaria , Cardiopatías/diagnóstico por imagen , Cardiopatías/patología , Cardiopatías/etiología , Cardiopatías/complicaciones , FemeninoAsunto(s)
Absceso , Biomarcadores , Valor Predictivo de las Pruebas , Troponina I , Humanos , Troponina I/sangre , Biomarcadores/sangre , Absceso/diagnóstico por imagen , Absceso/microbiología , Absceso/cirugía , Endocarditis/diagnóstico por imagen , Endocarditis/cirugía , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/diagnóstico por imagen , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/cirugía , Masculino , Femenino , Persona de Mediana EdadRESUMEN
In this retrospective/prospective study, we assessed the role of fundoscopy in 711 episodes with suspected infective endocarditis (IE); 238 (33%) had IE. Ocular embolic events (retinal emboli or chorioretinitis/endophthalmitis) and Roth spots were found in 37 (5%) and 34 (5%) episodes, respectively, but had no impact on IE diagnosis.
Asunto(s)
Embolia , Endocarditis Bacteriana , Endocarditis , Humanos , Estudios de Cohortes , Estudios Retrospectivos , Estudios Prospectivos , Endocarditis/diagnóstico , Endocarditis Bacteriana/diagnóstico por imagenRESUMEN
BACKGROUND: Right-sided infective endocarditis (RSIE) is a relatively uncommon condition which is difficult to distinguish from thrombus, particularly when the site of infection or the patient's symptoms are atypical. There have been few reports exploring the differential diagnostic and analytical features between RSIE and thrombus. CASE PRESENTATION: Here, we presented two cases of RSIE-one involving the tricuspid valve and the other affecting the pulmonary artery. Notably, the second case was initially misdiagnosed as thrombus based on the findings of by computed tomography angiography(CTA). CONCLUSIONS: Vegetation and thrombus can be distinguished according to the nature of the mass, its attachment location, and the clinical manifestation. Echocardiography can observe both the location and size of the mass, and the dynamic changes in cardiac hemodynamics and cardiac morphology, thereby facilitating an effective distinction between vegetation and thrombus.
Asunto(s)
Endocarditis Bacteriana , Endocarditis , Trombosis , Humanos , Endocarditis/diagnóstico por imagen , Ecocardiografía , Válvula Tricúspide/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Trombosis/diagnóstico por imagen , Endocarditis Bacteriana/diagnóstico por imagenRESUMEN
Mitral valve aneurysm (MVA) is characterized by a saccular outpouching of the mitral leaflet, and it represents a rare condition typically associated with aortic valve endocarditis. Three-Dimensional Transesophageal Echocardiography (3D-TEE) serves as an effective tool for detecting the presence of MVA and its potential complications. In this report, we present a case involving a young man with striking images of bicuspid aortic valve endocarditis complicated by an aortic root abscess and multiple perforated mitral valve aneurysms, diagnosed using 3D TEE. This case suggests the uncommon coexistence of Marfan like morphotype, bicuspid aortic valve, and infective endocarditis as a triple mechanism in the occurrence of MVA. It underscores the significance of early and accurate imaging diagnosis for facilitating prompt surgical intervention.
Asunto(s)
Enfermedad de la Válvula Aórtica Bicúspide , Ecocardiografía Tridimensional , Endocarditis Bacteriana , Endocarditis , Aneurisma Cardíaco , Síndrome de Marfan , Humanos , Masculino , Absceso/diagnóstico por imagen , Absceso/etiología , Aorta Torácica , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/cirugía , Enfermedad de la Válvula Aórtica Bicúspide/complicaciones , Ecocardiografía Transesofágica/métodos , Endocarditis/complicaciones , Endocarditis/diagnóstico por imagen , Endocarditis Bacteriana/complicaciones , Endocarditis Bacteriana/diagnóstico por imagen , Endocarditis Bacteriana/cirugía , Aneurisma Cardíaco/etiología , Aneurisma Cardíaco/complicaciones , Síndrome de Marfan/complicaciones , Síndrome de Marfan/diagnóstico , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/cirugíaRESUMEN
A 68-year-old male patient was admitted for extremities edema and diagnosed with infective endocarditis (IEIE). The patient underwent mitral and aortic valve mechanical valve replacement due to rheumatic heart valve disease 26 years ago. He underwent mechanical aortic valve and bioprosthetic tricuspid valve replacement due to mechanical aortic valve dysfunction and severe tricuspid valve regurgitation 1 year ago. Two months ago, the patient underwent emergency permanent pacemaker implantation due to syncope caused by a third-degree atrioventricular block. The patient was admitted to the emergency with fever and worsening dyspnea 1 h ago. Transthoracic echocardiography revealed prosthetic aortic valve severe paravalvular leak and tricuspid valve stenosis with vegetation. The patient was scheduled to undergo mechanical aortic valve and bioprosthetic tricuspid valve replacement under median thoracotomy. The intraoperative transesophageal echocardiography (TEE) view showed severe paravalvular aortic valve leakage and tricuspid valve vegetation. The coronary sinus was significantly enlarged with thrombus formation, vegetation can be seen in the bioprosthetic tricuspid valve leaflets. This is a rare case of infective endocarditis with tricuspid stenosis and coronary sinus thrombosis after the placement of implanted pacemakers.
Asunto(s)
Endocarditis Bacteriana , Endocarditis , Implantación de Prótesis de Válvulas Cardíacas , Marcapaso Artificial , Estenosis de la Válvula Tricúspide , Masculino , Humanos , Anciano , Estenosis de la Válvula Tricúspide/diagnóstico por imagen , Estenosis de la Válvula Tricúspide/etiología , Endocarditis Bacteriana/complicaciones , Endocarditis Bacteriana/diagnóstico por imagen , Endocarditis/complicaciones , Endocarditis/diagnóstico por imagen , Marcapaso Artificial/efectos adversosAsunto(s)
Buceo , Endocarditis Bacteriana , Endocarditis , Cardiopatías , Humanos , Buceo/efectos adversos , Endocarditis Bacteriana/complicaciones , Endocarditis Bacteriana/diagnóstico por imagen , Antibacterianos/uso terapéutico , Cardiopatías/tratamiento farmacológico , Endocarditis/etiología , Endocarditis/tratamiento farmacológicoAsunto(s)
Endocarditis Bacteriana , Endocarditis , Prótesis Valvulares Cardíacas , Infecciones Relacionadas con Prótesis , Humanos , Ecocardiografía Transesofágica , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/cirugía , Endocarditis Bacteriana/diagnóstico por imagen , Prótesis Valvulares Cardíacas/efectos adversos , Infecciones Relacionadas con Prótesis/diagnóstico por imagen , Infecciones Relacionadas con Prótesis/etiologíaRESUMEN
BACKGROUND: To determine the prevalence, the clinical and radiological features, associated factors, treatment, and outcome of splenic artery aneurysms (SAAs) in infective endocarditis (IE). METHODS: We retrospectively reviewed 474 consecutive patients admitted to our institution with definite IE (2005-2020). RESULTS: Six patients had SAAs (1.3%; 3 women; mean age: 50 years). In all cases, the diagnosis was obtained by abdominal computed tomography angiography (CTA). SAAs-IE were solitary and saccular with a mean diameter of 30 mm (range: 10-90 mm). SAAs-IE were intrasplenic (n = 4) or hilar (n = 2). Streptococcus spp. were the predominant organisms (n = 4). In all cases, a left-sided native valve was involved (aortic, n = 3; mitral, n = 2; mitral-aortic, n = 1). SAAs were silent in half patients and were revealed by abdominal pain (n = 2) and by the resurgence of fever after cardiac surgery (n = 1). All patients underwent emergent valve replacement. One patient died within 24 hr from multiorgan failure. For the others, uneventful coil embolization was performed in 4 patients after valve replacement (3 diagnosed early and 1 at 8 weeks). In the remaining patient, SAA-IE diagnosed at abdominal CTA at day 16, with complete resolution under appropriate antibiotherapy alone. CONCLUSIONS: SAAs-IE are a rare occurrence that may be clinically silent. SAAs-IE can be intrasplenic or hilar in location. Endovascular treatment in this context was safe. According to current guidelines, radiologic screening by abdominal CTA allowed the detection of silent SAAs which could be managed by endovascular treatment to prevent rupture. The delayed formation of these SAAs could justify a CTA control at the end of antibiotherapy.