Butterfly in the Heart: Infective Endocarditis after MitraClip Procedure.
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ABSTRACT:
SUBMITTER: Roslan A
PROVIDER: S-EPMC6058410 | biostudies-literature | 2018 Apr
REPOSITORIES: biostudies-literature
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Butterfly in the Heart: Infective Endocarditis after MitraClip Procedure.
Roslan Aslannif A Kamsani Suraya Hani SH Jauhari Aktifanus Ahmad Tantawi AT Krishnan Malini M Hakim Najmi N Megat Samsudin Wan Nabeelah WN
CASE (Philadelphia, Pa.) 20180215 2
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Project description:BackgroundThe incidence of infective endocarditis (IE) following a MitraClip is rare with 17 reported cases in the literature. The reported mortality rate is high, at 41%, despite both medical and surgical therapies. To date, this is the first documented case of IE following a MitraClip procedure in Australia.Case summaryAn 88-year-old male presented with a 1-week history of confusion and dyspnoea. Clinical examination was significant for a temperature of 37.7°C, a pansystolic murmur and bilateral pitting oedema to mid-shin, but no peripheral stigmata of IE. His history included a MitraClip procedure 11 weeks prior for severe mitral regurgitation. Initial blood cultures grew enterococcus faecalis. A transthoracic echocardiogram did not identify vegetations on the MitraClip. Subsequent transoesophageal echocardiogram (TOE) identified a 4 mm × 2 mm echodensity on the posterior mitral valve leaflet suggestive of IE. He was deemed not suitable for surgical intervention due to poor cognitive reserve and his medical comorbidities, so he commenced intravenous (IV) Ampicillin and Ceftriaxone which was later changed to Benzylpenicillin. Repeat TOE 2 weeks later showed the vegetation to have increased to ∼1 cm in length, so his treatment was reverted to Ampicillin. A further TOE 4 weeks later showed reduction in size to 5 mm × 2 mm. After 6 weeks of IV antibiotics, the patient was discharged on lifelong oral antibiotics.DiscussionInfective endocarditis following MitraClip procedure is rare. This disease has a high mortality rate despite optimal medical and surgical therapy. Increased awareness amongst clinicians is important given an increasing volume of MitraClip procedures.
| S-EPMC7780467 | biostudies-literature
Project description:PurposeProgress of interventional cardiology has boosted the use of newer cardiac devices. These devices are perceived to be less prone to infections compared to traditional surgical prostheses, but little data are currently available. In this systematic review (SR), we summarize current literature regarding the clinical characteristics, management, and outcomes of patients with MitraClip-related infective endocarditis (IE).MethodsWe conducted a SR of PubMed, Google Scholar, Embase, and Scopus between January 2003 and March 2022. MitraClip-related IE was defined according to 2015 ESC criteria whereas MitraClip involvement as vegetation on the device or on the mitral valve. Risk of bias was assessed through standardized checklist and potential bias of underestimation cannot be excluded. Data regarding clinical presentation, echocardiography, management, and outcome were collected.ResultsTwenty-six cases of MitraClip-related IE were retrieved. The median age of patients was 76 [61-83] years with a median EuroScore of 41%. Fever was present in 65.8% of patients followed by signs and symptoms of heart failure (42.3%). IE occurred early in 20 (76.9%) cases with a median time between MitraClip implantation and IE symptom onset of 5 [2-16] months. Staphylococcus aureus was the major causative microorganism (46%). Surgical mitral valve replacement was needed in 50% of patients. A conservative medical approach was considered in the remainder. The overall in-hospital mortality rate was 50% (surgical group: 38.4%; medical group: 58.3%; p = 0.433).ConclusionOur results suggest that MitraClip-related IE affects elderly, comorbid patients, is mostly due to Staphylococcus aureus, and has a poor prognosis irrespective of the therapeutic approach. Clinicians must be aware of the features of this new entity among cardiovascular infections.
| S-EPMC10545607 | biostudies-literature
Project description:BackgroundTranscatheter edge-to-edge mitral valve repair using the MitraClip device is increasingly used for high surgical risk patients with severe mitral regurgitation (MR). Previous guidelines for infective endocarditis prophylaxis prior to dental procedures focused on high-risk patients, but without explicit recommendation for MitraClip recipients. We believe this could be the first reported case to identify Streptococcus oralis as the causative organism.Case presentationAn 87-year-old male with severe MR treated with two MitraClip devices three months prior to index admission, presented with worsening malaise and intermittent chills on a background of multiple comorbid conditions. The patient had dental work a month prior to presentation, including a root canal procedure, without antibiotic prophylaxis. Vitals were significant for fever and hypotension. On physical examination, there was a holosystolic murmur at the apex radiating to the axilla, bilateral pitting edema in the lower extremities, and elevated jugular venous pulsation. A transthoracic echocardiogram showed severe MR with a possible echodensity on the mitral valve, prompting a transesophageal echocardiogram, which demonstrated a pedunculated, mobile mass on the posterior leaflet of the mitral valve. Five blood cultures grew gram positive cocci in pairs and chains, later identified as Streptococcus oralis, with minimum inhibitory concentration to penicillin 0.06 mg/L. Initial empiric antibiotics were switched to ceftriaxone 2 gr daily and subsequent blood cultures remained negative. However, the patient developed pulmonary edema and worsening hemodynamic instability requiring vasopressors. As surgical risk for re-operation was considered prohibitive, the decision was made to continue medical management and comfort-directed care. The patient died a week later.ConclusionsDespite low incidence, infective endocarditis should be included in the differential among MitraClip recipients. The explicit inclusion of this growing patient population in the group requiring prophylaxis prior to dental procedures in the 2020 ACC/AHA valvular heart disease guidelines is an important step forward.
| S-EPMC8403350 | biostudies-literature
Project description: Not available
| S-EPMC7925964 | biostudies-literature
Project description:BackgroundThe Ross procedure can be an ideal option in infective endocarditis (IE) due to greater resistance to infection. However, limited literature has highlighted the comparison with conventional prostheses in this setting.MethodsBetween February 2013 and September 2022, 25 patients (median age, 50 years) underwent a Ross procedure for IE (Ross group). The results were compared with those after other aortic valve procedures (aortic valve replacement and aortic root replacement) for IE (n = 37, other group.ResultsThe patients in the Ross group included more intravenous drug users and had more prosthetic valve endocarditis and annular abscess formation compared with the other group. Although cardiopulmonary bypass time and aortic cross-clamp time were significantly longer (P < .001 and P = .003, respectively) and the blood requirements were significantly higher (P = .001) in the Ross group, most postoperative short-term outcomes were equivalent between the 2 groups. During follow-up, 1 patient (4%) required reoperation in the Ross group, whereas 6 patients (16%) required reoperation in the other group. Freedom from composite events was significantly better in the Ross group (P = .04). Multivariable analysis found the Ross procedure, compared with other procedures, was a significant independent protective factor for composite end points (P = .03).ConclusionsFor IE, despite surgical complexity, the Ross procedure yielded short-term outcomes similar to other procedures. In the midterm, the Ross procedure provides a lower reoperation rate, resulting in significantly fewer composite events. The Ross procedure appears to be a better option for patients with IE, but long-term follow-up is necessary.
| S-EPMC11910771 | biostudies-literature
Project description:Background: Infective endocarditis (IE) is an infectious disease caused by the hematogenous dissemination of bacteria into heart valves. Improving the identification of pathogens that cause IE is important to increase the effectiveness of its therapy and reduce the mortality caused by this pathology. Methods: Ten native heart valves obtained from IE patients undergoing heart valve replacements were analyzed. Bacterial invasion in the heart valves was studied by Gram staining of histological sections. Histopathological changes accompanied with bacterial invasion were studied by immunohistochemical analysis of pan-leukocyte marker CD45, platelet marker CD41, and neutrophil myeloperoxidase. The taxonomic diversity of the bacteria was analyzed using 16S rRNA metabarcoding. Results: Gram staining of the histological sections revealed bacterial cells localized on the atrial surface at the leaflet's free edge or on the ventricular surface at the leaflet's base within fibrin deposits in only three of the studied heart valves. Bacterial colonies were co-localized with microthrombi (CD41+ cells) containing single leucocytes (CD45+ cells), represented by segmented neutrophils. As a result of 16S rRNA metabarcoding, we detected the following bacterial genera: Pseudomonas (70% of the studied heart valves), Roseateles (60%), Acinetobacter (40%), Sphingomonas (40%), Enterococcus (30%), Reyranella (20%), Sphingobium (20%), Streptococcus (20%), Agrobacterium (20%), Ralstonia (10%), and Bacillus (10%). Conclusions: A number of opportunistic microorganisms that could not be detected by routine laboratory tests and were not eliminated during antibiotic therapy were identified in the IE-affected heart valves. The obtained results show the importance of 16S rRNA metabarcoding of heart valves removed due to IE not only as an independent diagnostic method but also as a highly accurate approach that complements routine tests for pathogen identification.
| S-EPMC11762347 | biostudies-literature
Project description:In this article, we introduced a case of rare congenital anomalies that was asymptomatic until adulthood and was complicated by infective endocarditis and dissection of aortic valve leaflet.
| S-EPMC8212014 | biostudies-literature
Project description: Not available
| S-EPMC6018331 | biostudies-literature