Challenges and Insights in Aggregatibacter aphrophilus endocarditis: a review of literature.

Infective endocarditis is a serious disease associated with high mortality despite recent advances in diagnosis and treatment. Aggregatibacter aphrophilus is a fastidious Gram-negative member of the HACEK organisms (Haemophilus spp., Aggregatibacter actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, and Kingella kingae). A. aphrophilus is associated with dental infections but has also been implicated in cases of infective endocarditis. We highlight the importance of a high index of suspicion in symptomatic patients with an initial negative blood culture, particularly in high-risk groups such as patients with congenital valve disease and prosthetic valve. The knowledge of this rare entity may lead to early diagnosis and appropriate management. We review the main characteristics of Aggregatibacter aphrophilus endocarditis reported in the medical literature.

La endocarditis infecciosa es una enfermedad grave que está asociada con una alta mortalidad a pesar de los avances recientes en el diagnóstico y tratamiento. Aggregatibacter aphrophilus es un miembro Gram-negativo de los organismos HACEK (Haemophilus spp., Aggregatibacter actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens y Kingella kingae). A. aphrophilus está relacionado con infecciones dentales, pero también ha estado implicado en casos de endocarditis infecciosa. Se destaca la importancia de tener un alto índice de sospecha en pacientes sintomáticos con un cultivo sanguíneo inicial negativo, especialmente en grupos de alto riesgo como pacientes con enfermedad valvular congénita y válvula protésica. El conocimiento de esta entidad poco común puede llevar a un diagnóstico temprano y un manejo adecuado. Revisamos las principales características de la endocarditis por Aggregatibacter aphrophilus reportadas en la literatura médica.

An unusual case of Candida parapsilosis endocarditis of the native tricuspid valve secondary to a tunneled dialysis catheter.

Candida endocarditis is a severe disease associated with high mortality rates. Candida parapsilosis is frequently identified as the causative pathogen in intravenous drug users and is commonly associated with nosocomial infections, primarily due to its ability to form biofilms on catheters or other foreign bodies. Here, we present a rare case of Candida parapsilosis endocarditis affecting the native tricuspid valve in a 35-year-old male patient with end-stage chronic kidney disease (Stage V), who had a suspected fungal infection related to the left cervical catheter. The patient received treatment with caspofungin and underwent excision of a verrucous tumor on the tricuspid valve. Despite encountering postoperative complications, the patient was discharged on fluconazole treatment and scheduled for follow-up. Candida endocarditis poses a clinical challenge that necessitates a multidisciplinary approach and tailored management due to its infrequent occurrence and higher mortality rate compared to bacterial endocarditis.

La endocarditis por Candida es una enfermedad grave asociada con tasas de mortalidad elevadas. Candida parapsilosis se identifica con frecuencia como un patógeno que afecta usuarios de drogas intravenosas y está comúnmente relacionada con infecciones nosocomiales, principalmente debido a su capacidad para formar biopelículas en catéteres u otros cuerpos extraños. Se presenta un caso inusual de endocarditis por Candida parapsilosis que afecta la válvula tricúspide nativa en un paciente masculino de 35 años con enfermedad renal crónica en etapa terminal (Etapa V), quien tenía una sospecha de infección fúngica relacionada con el catéter cervical izquierdo. El paciente recibió tratamiento con caspofungina y se sometió a la extirpación de un tumor verrugoso en la válvula tricúspide. A pesar de enfrentar complicaciones posoperatorias, el paciente fue dado de alta con tratamiento de fluconazol y se programó un seguimiento. La endocarditis por Candida presenta un desafío clínico que requiere un enfoque multidisciplinario y un manejo personalizado debido a su ocurrencia infrecuente y una tasa de mortalidad más alta en comparación con la endocarditis bacteriana.

[Right hemitruncus in adulthood: an unusual finding]. / Hemitruncus derecho en la vida adulta: un hallazgo poco usual.

Hemitruncus arteriosus is a rare congenital heart disease characterized by the abnormal origin of one of the branches of the pulmonary artery from the ascending aorta. In most cases, its diagnosis is made during childhood; in addition, due to its high morbidity and mortality, its asymptomatic evolution and survival to adulthood is extremely unusual. We present the case of a 30-year-old male patient, with a history of surgical closure of patent ductus arteriosus during childhood, who was asymptomatic until a year ago, in whom hemitruncus arteriosus was diagnosed after recurrent episodes of hemoptysis.

[Analysis of cardiac surgeries and operative mortality at the National Cardiovascular Institute during 2022]. / Análisis de las cirugías cardíacas y mortalidad operatoria en el Instituto Nacional Cardiovascular durante el 2022.

Objective: To describe cardiac surgeries, their approaches, and determine operative mortality according to the type of surgery and the main complications recorded within 30 days postoperatively, performed at the National Cardiovascular Institute of Peru. Materials and methods: A descriptive study was conducted on all patients over 18 years of age who underwent cardiovascular surgery at the National Cardiovascular Institute "Carlos Alberto Peschiera Carrillo". Results: During the year 2022, a total of 503 cardiac surgeries were performed. Of the patients undergoing surgery, 63.6% (320) were males. Isolated valvular surgery, primarily aortic or mitral valve replacement, was the most frequent surgical procedure, with 136 surgeries (27.0%). This was followed by myocardial revascularization surgery with 110 procedures (21.9%). Throughout the year, there were 23 deaths, resulting in an overall mortality rate of 4.5%. The mortality rate for elective surgeries was 2.8%, while for emergency surgeries, it was 14.3%. The most common complication was paroxysmal atrial fibrillation (14.0%), followed by surgical site infection with 52 cases (10.3%). Conclusions: Valvular surgery, whether isolated or combined with other procedures, was the most frequently performed. The obtained mortality rate is considered acceptable for a reference center.

Is It Possible to Place a Pacemaker Lead Through a Bileaflet Mechanical Prosthesis?

We present a 64-year-old woman who underwent mitral, aortic, and tricuspid valve (TV) replacement with mechanical prostheses. Two months after TV surgery, she presented third-degree atrioventricular block. After attempting to place a pacemaker lead through the coronary sinus, it was placed through the mechanical valve in the tricuspid position as the last option. At 1 year of follow-up, the device shows no signs of dysfunction, and the prosthesis has moderate regurgitation.

Pulmonary Valve Reconstruction Using Autologous Pericardium: A Promising Technique to Consider.

Pulmonary valve (PV) surgical treatment is uncommon in adults; however, when it is indicated, replacement with a prosthesis is suggested. Nevertheless, mechanical prostheses have an inherent risk of complications derived from anticoagulation and thrombosis, and biologic prostheses do not have adequate long-term durability. In this context, PV reconstruction surgery emerges as an alternative, avoiding anticoagulation and promising good durability. We present our experience with this procedure in 3 patients with severe PV insufficiency and 1 patient with severe PV stenosis.

[Epidemiological characteristics of heart transplant recipients in Peru 2010-2020]. / Características epidemiológicas de receptores de trasplante cardiaco en el Perú, 2010-2020.

Objective: To evaluate the epidemiological, clinical, surgical, pathological characteristics and outcomes in the follow-up of heart transplant recipients at the National Cardiovascular Institute during 2010-2020. Material and Methods: A retrospective descriptive study was performed by reviewing the medical records of patients undergoing heart transplantation at a national referral center, describing the clinical, surgical, laboratory, pathology characteristics and survival of patients up to 10 years of follow-up. Results: Eighty-six patients were transplanted in 10 years, the median age was 41 years (RIQ 28-56), being predominantly male (66.3%). The three leading causes of indication for heart transplantation were: dilated cardiomyopathy (48.9%), ischemic heart disease (17.4%), and myocarditis (6.9%). Total ischemia time was 160 minutes (RIQ 129.7-233.5). Survival at one, five, and ten years was 84.8%, 73.6%, and 65.7% respectively. The main cause of death was non-cardiac: infectious (39.1%) and of unknown origin (26%). Conclusions: The main etiology of heart failure in heart transplant recipients in Peru in recent years was nonischemic dilated cardiomyopathy. We observed that the survival rate was similar to that of international registries; however, the rate of mortality due to infectious causes and death of unknown origin is high, which poses a challenge in the management of post-transplant patients.