Complete dehiscence and unseated prosthetic aortic valve causing severe aortic insufficiency: an unusual complication of prosthetic valve endocarditis.
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ABSTRACT:
SUBMITTER: Krishna RK
PROVIDER: S-EPMC4208107 | biostudies-literature | 2014 Oct
REPOSITORIES: biostudies-literature
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Complete dehiscence and unseated prosthetic aortic valve causing severe aortic insufficiency: an unusual complication of prosthetic valve endocarditis.
Krishna Rama K RK Casanova Paola P Larrauri-Reyes Maiteder M Santana Orlando O
BMJ case reports 20141024
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Project description:Late prosthetic valve endocarditis (PVE) is a life-threatening condition, commonly caused by bacterial organisms such as staphylococci, streptococci, or enterococci. Infrequently, it can be caused by rare organisms. We hereby report a case of late PVE of the aortic valve, due to a rare gram-negative bacterium Pandoraea pnomenusa. It is the first reported case of PVE caused by this particular organism. The patient had infective endocarditis-induced prosthetic valve dehiscence, severe aortic regurgitation, and shock, which was managed with appropriate antibiotics and supportive medical treatment. <Learning objective: Late prosthetic valve infective endocarditis should always be an important differential diagnosis in patients with artificial valve presenting with congestive cardiac failure. This case report is about aortic valve dehiscence and acute aortic regurgitation because of prosthetic valve infective endocarditis due to a rare bacterium Pandoraea pnomenusa.>.
| S-EPMC8258266 | biostudies-literature
Project description:We report a case of Mycoplasma genitalium endocarditis in a prosthetic heart valve of a woman who sought care in Switzerland for acute aortic valve dysfunction 3 years after valve replacement. This unusual manifestation of infection with this bacterium was diagnosed using broad-range PCR despite suspicion of a mechanical disinsertion.
| S-EPMC10521615 | biostudies-literature
Project description:IntroductionInvasive infections due to Cellulosimicrobium spp. (a Gram-positive coryneform) are extremely rare. Only a few cases of bloodstream infections and endocarditis have been described, as bacteraemia due to coryneforms is usually discarded as blood culture contamination.Case presentationA 66-year-old female, with a history of aortic valve replacement, presented with fever, left leg purpura and acute kidney injury. Multiple repeated blood cultures were positive for Cellulosimicrobium cellulans , and targeted therapy was started. At first, endocarditis was excluded by echocardiograms, and the acute nephritis was interpreted as an atypical presentation of Henoch-Shönlein purpura. High-dose prednisone was started, and after 10 weeks the patient presented again with fever, mental confusion and acute left arm ischaemia. A subsequent echocardiogram and radiolabelled leukocyte scintigraphic evaluation revealed aortic prosthetic valve endocarditis with periprosthetic abscess and arterial brachial thrombosis. The patient deceased, and the autoptic examination confirmed an aortic valve periprosthetic abscess and revealed multiple arterial thromboses and septic embolisms in the kidneys, brain, spleen and myocardium.ConclusionIsolation of coryneform bacteria on blood culture should not always be discarded as blood culture contamination. In the case of endocarditis due to Cellulosimicrobium spp., the removal of any prosthetic material, along with prolonged in vitro active antimicrobial therapy, should be pursued in order to reduce persistence or relapses of infection.
| S-EPMC7491936 | biostudies-literature
Project description:An 80-year-old male underwent a transcatheter aortic valve implantation (TAVI) for severe senile aortic stenosis. Six weeks after the surgery, he was readmitted to our institution because of a high-grade fever. Transesophageal echocardiography revealed thickening of all three leaflets of the aortic prosthesis and mobile mass on the leaflet, and Streptococcus sanguis was identified from his blood culture. Therefore, he was diagnosed with prosthetic valve endocarditis (PVE) and received intensive intravenous antibiotic therapy. Because he did not respond to the pharmacological therapy, surgical aortic valve replacement (AVR) was indicated although it was considered a relatively high-risk procedure. Herein, we report on the successful surgical AVR in this patient using a pericardial valve after removal of the infected prosthetic valve, and discuss some issues related to this rare complication after TAVI. <Learning objective: Transcatheter aortic valve implantation (TAVI) is a highly effective procedure for patients with symptomatic severe aortic stenosis who are at high risk or deemed inoperable. Because it only requires limited surgical invasiveness, the risk of prosthetic valve endocarditis (PVE) after TAVI is thought to be low. However, PVE can occur even early after TAVI. We present our recent such case and discuss some issues related to this rare complication.>.
| S-EPMC6279805 | biostudies-literature
Project description:We report a case of infective endocarditis complicated with left ventricular pseudoaneurysm originating from the posterior annulus of the prosthetic mitral valve in a 56-year-old woman. Despite prolonged antibiotic treatment, transesophageal echocardiography (TEE) showed partial detachment of the prosthesis from the posterior mitral annulus. Three-dimensional rotational computed tomography clearly demonstrated a pseudoaneurysm toward the posterolateral portion of the mitral prosthetic valve, which was not evident by TEE. Valve replacement and repair of the pseudoaneurysm were performed 83 days after initiation of antibiotic therapy. Left ventricular pseudoaneurysm is a rare but serious complication of mitral prosthetic valve endocarditis. It requires prompt diagnosis and early surgical intervention. <Learning objective: We present a case of infective endocarditis (IE) complicated with left ventricular pseudoaneurysm originating from the prosthetic mitral valve. Repeated transesophageal echocardiography is recommended for all IE patients when perivalvular extension is suspected. Electrocardiography-gated three-dimensional-computed tomography is useful for detection and evaluation of pseudoaneurysm, especially in planning surgical procedures.>.
| S-EPMC6281488 | biostudies-literature
Project description:BackgroundWhether a bovine or porcine aortic valve bioprosthesis carries a higher risk of endocarditis after aortic valve replacement is unknown. The aim of this study was to compare the risk of prosthetic endocarditis in patients undergoing aortic valve replacement with a bovine versus porcine bioprosthesis.Methods and resultsThis nationwide, population-based cohort study included all patients who underwent surgical aortic valve replacement with a bovine or porcine bioprosthesis in Sweden from 1997 to 2018. Regression standardization was used to account for intergroup differences. The primary outcome was prosthetic valve endocarditis, and the secondary outcomes were all-cause mortality and early prosthetic valve endocarditis. During a maximum follow-up time of 22 years, we included 21 022 patients, 16 603 with a bovine valve prosthesis and 4419 with a porcine valve prosthesis. The mean age was 73 years, and 61% of the patients were men. In total, 910 patients were hospitalized for infective endocarditis: 690 (4.2%) in the bovine group and 220 (5.0%) in the porcine group. The adjusted cumulative incidence of prosthetic valve endocarditis at 15 years was 9.5% (95% CI, 6.2%-14.4%) in the bovine group and 2.8% (95% CI, 1.4%-5.6%) in the porcine group. The absolute risk difference between the groups at 15 years was 6.7% (95% CI, 0.8%-12.5%).ConclusionsThe risk of endocarditis was higher in patients who received a bovine compared with a porcine valve prosthesis after surgical aortic valve replacement. This association should be considered in patients undergoing both surgical and transcatheter aortic valve replacement.
| S-EPMC10863842 | biostudies-literature
Project description:A 74-year-old man with a history of bioprosthetic aortic valve replacement presented with acute severe aortic insufficiency and cardiogenic shock secondary to Diphtheroides and Enterococcus endocarditis. The patient was deemed to be not a surgical candidate by the multidisciplinary team and underwent rescue transcatheter aortic valve-in-valve replacement, resulting in complete recovery. (Level of Difficulty: Advanced.).
| S-EPMC9666743 | biostudies-literature
Project description:We describe the case of a 64-year-old woman presenting with severe prosthetic mitral valve endocarditis 1 year after coronary artery bypass grafting and double valve replacement. Echocardiogram revealed high-pressure gradients through the bioprosthetic MV with a bulky vegetation. As the patient had presented operative difficulties due to severe mitral annular calcification, was in renal failure, and in the absence of any perivalvular involvement, an open-heart surgical catheter-based valve implantation was successfully performed after removal of the infected leaflets, leaving the stent frame and sewing cuff behind. Albeit controversial, this case represents an alternative approach for select high-risk reoperative mitral cases with mitral annular calcification.
| S-EPMC7365828 | biostudies-literature
Project description:We present a case of a ruptured mitral valve (MV) aneurysm as a complication of a bicuspid aortic valve (BAV) endocarditis. It is about a young 35-year-old man, admitted to Cardiology Unit because of unexpected heart failure picture. We found a BAV endocarditis complicated by anterior MV-anterior leaflet aneurysm formation and subsequent severe MV regurgitation caused by aneurysm perforation. It was a particular and rare situation characterized by an infection of anterior mitral leaflet secondary to an infected regurgitant jet of a primary aortic infective endocarditis due to a BAV. A resulting aneurysm formation on the atrial side of the mitral anterior leaflet leads later to mitral perforation. In this article, we review the more relevant medical literature on this topic.
| S-EPMC5353471 | biostudies-literature
Project description:A 70-year-old female patient with a history of bioprosthetic aortic valve replacement and coronary artery bypass graft presented with bioprosthetic valve failure secondary to prosthetic valve endocarditis. The patient was deemed unsuitable for surgery by the heart team, following which she underwent transcatheter aortic valve-in-valve replacement. This resulted in early death due to myocardial infarction and acute heart failure. A computed tomography revealed subclinical leaflet thrombosis. This case highlights the importance of postoperative anticoagulation therapy.
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