An Aortic Root Abscess Presenting as a Suprasternal Pulsatile Mass.
Ontology highlight
ABSTRACT:
SUBMITTER: Raman K
PROVIDER: S-EPMC6559191 | biostudies-literature | 2019 Jun
REPOSITORIES: biostudies-literature
Publications
An Aortic Root Abscess Presenting as a Suprasternal Pulsatile Mass.
Raman Karthik K Sheriff Ejaz Ahmed EA Jamesraj Jacob J Kumar Ram R
The Korean journal of thoracic and cardiovascular surgery 20190605 3
Prosthetic valve endocarditis with aortic root abscess is a serious condition requiring urgent surgical intervention. We present a case caused by an infected Bentall mechanical valve conduit after cardiac surgery in a patient who was referred for a suprasternal pulsatile mass. The patient also had 1 episode of sentinel haemorrhage. ...[more]
Similar Datasets
Project description:Over the last decade, transcatheter treatment of degenerative aortic valve stenosis has been established as an alternative to surgical aortic valve replacement. Late complications of transcatheter treatment of aortic stenosis (AS) are infrequent. We report an 87-year-old woman treated successfully with 23 mm Sapien 3 transapical transcatheter aortic valve implantation for severe AS. She presented 4 months later with a pulsatile mass in the left breast. After exclusion of other diagnoses, the mass was attributed to a sterile abscess communicating with the pericardial cavity due to post-operative chest infection and pleural effusion. Multimodality imaging helped to define the anatomy of the abscess and the mechanism of the pulsation. This is the first report of a pulsatile sterile abscess occurring as a complication of transapical aortic valve implantation. Multimodality imaging confirmed that the pulsation was due to extension of the abscess into the pericardial cavity, excluded direct communication with the left ventricle, and facilitated successful non-surgical management.
| S-EPMC6601158 | biostudies-literature
Project description:The present report describes a case of infective endocarditis complicated with aortic root abscess caused by Cardiobacterium hominis in a 56-year-old man. C. hominis is a microaerophilic, pleomorphic Gram-negative bacillus and member of the Haemophilus species, Aggregatibacter actinomycetemcomitans , C. hominis , Eikenella corrodens and Kingella kingae (HACEK) group, a group of bacteria known to be a rare cause of endocarditis. With prompt diagnosis and initiation of antimicrobial and surgical management, a successful outcome was achieved.
| S-EPMC7472547 | biostudies-literature
Project description:Locally destructive infective endocarditis (IE) of the aortic valve complicated by abscess formation in the aortic root may seriously affect patients' outcomes. Surgical repair of such conditions is often challenging. This is a single-center observational analysis of consecutive patients treated surgically for IE between 2009 and 2019. We divided the cohort into two groups considering the presence of an aortic root abscess and compared the characteristics and postoperative outcomes of patients accordingly. Moreover, we examined three different procedures performed in abscess patients regarding operative data and postoperative results: an isolated surgical aortic valve replacement (AVR), AVR with patch reconstruction of the aortic root (AVR + RR) or the Bentall procedure. The whole cohort comprised 665 patients, including 140 (21.0%) patients with an aortic root abscess and 525 (78.9%) as the control group. The abscess group of patients received either AVR (66.4%), AVR + RR (17.8%), or the Bentall procedure (15.7%). The mean age in the whole cohort was 62.1 ± 14.8. The mean EuroSCORE II was 8.0 ± 3.5 in the abscess group and 8.4 ± 3.7 in the control group (p = 0.259). The 30-day and 1-year mortality rates were 19.6% vs. 11.3% (p = 0.009) and 40.1% vs. 29.6% (p = 0.016) in the abscess compared to the control group. The multivariable regression analysis did not reveal aortic root abscess as an independent predictor of mortality. Rather, age > 60 correlated with 30-day mortality and infection with Streptococcus spp. correlated with 1-year mortality. In the analysis according to the performed procedures, KM estimates exhibited comparable long-term survival (log-rank p = 0.325). IE recurrence was noticed in 12.3% of patients after AVR, 26.7% after AVR + RR and none after Bentall (p = 0.069). We concluded that patients with an aortic root abscess suffer worse short and long-term outcomes compared to other IE patients. The post-procedural survival among ARA patients did not significantly vary based on the procedures performed.
| S-EPMC10820780 | biostudies-literature
Project description:BackgroundInfective endocarditis is a serious infection associated with high mortality and severe complications, such as heart failure, uncontrolled infection, and embolic events. Certain populations, including individuals with a prosthetic valve and those with native valve disease, such as bicuspid aortic valve, are considered to be more at risk of developing infective endocarditis.Case summaryA 51-year-old previously healthy male presented with a 2-week history of persistent fever, malaise, and night sweats despite taking a long course of oral antibiotics. Examination was unremarkable; however, blood tests showed elevated inflammatory markers. Three sets of blood cultures revealed coagulase-negative gram-positive cocci (later identified as Staphylococcus lugdunensis), and the patient was subsequently started on IV antibiotics. His echocardiography showed a bicuspid aortic valve with severe regurgitation, and an aortic root abscess surrounding a dilated aortic root. In view of the presence of locally uncontrolled infection, the patient was referred for urgent debridement of the abscess and replacement of the aortic valve with tissue prosthesis. Fortunately, after a total of 6 weeks of IV antibiotics and successful operative management, our patient made a complete recovery.DiscussionThe development of an aortic root abscess occurs in 10-40% of cases of aortic valve endocarditis. Clinically, this should be suspected in any patient with endocarditis who fails to improve despite appropriate antibiotic therapy. This case demonstrates that severe infective endocarditis can develop in apparently healthy individuals due to underlying cardiac abnormalities.
| S-EPMC7649491 | biostudies-literature
Project description:BackgroundRheumatoid arthritis (RA) may involve the cardiovascular system and can cause significant structural cardiac disease. RA mimicking infective endocarditis (IE) is rarely reported.Case summaryA 46-year-old man with a medical history of seropositive RA attended a planned outpatient visit for infliximab treatment. The pre-infusion examination revealed a pulse of 41 b.p.m. and the following electrocardiogram showed 3rd degree atrioventricular block. A temporary pacemaker was inserted, and subsequent transthoracic and transoesophageal echocardiograms showed severe aortic valve regurgitation with thickened cusps and thus raised suspicion of infective aortic endocarditis with root abscess. The patient underwent surgery with valve and root replacement the next day. What was thought to be IE, proved to be suppurative and granulomatous inflammation with sporadic necrosis and hyaline fibrosis, compatible with a rheumatoid nodule linked to the patient's RA diagnosis.DiscussionIE is a disease with high mortality and morbidity. In some cases of IE perivalvular cavities develop, most commonly abscesses and/or pseudoaneurysms, which necessitates surgery. Several conditions may mimic IE: for example, malignant and benign tumours, rheumatic diseases, and common age-related valve calcification. In patients with valvular vegetations that are 'culture-negative', alternative pathologies should be considered.
| S-EPMC7898585 | biostudies-literature
Project description:Background:To our knowledge, we report the first case of endocarditis with root abscess causing compressive superior vena cava (SVC) obstruction. Case summary:An 84-year-old gentleman with previous tissue aortic valve replacement presented with fevers and systemic upset. Blood cultures grew Streptococcus anginosus and transoesophageal echocardiogram identified prosthetic valve vegetations with an associated root abscess. Antibiotics were commenced and referral made for surgical consideration. Several days into treatment the patient developed clinical signs of SVC obstruction and computed tomography demonstrated an enlarging root abscess with SVC compression. The patient was discussed with local cardiothoracic centres, but surgery was not an option primarily due to abscess size and vascular involvement. Priority moved from active to palliative treatment given no improvement with antibiotics, unsuitability for surgery, and patient discomfort. Within several weeks, symptoms/signs of SVC obstruction actually improved, likely due to collateral venous circulation formation and the patient was discharged home with palliative care input. Discussion:There are previous reports of SVC obstruction related to infected SVC thrombus, indwelling intravascular devices, and para-aortic abscess, but none related to infective endocarditis. Streptococcus anginosus endocarditis is rare but often associated with abscess formation, and male gender, increasing age, and previous surgery are recognized risk factors.
| S-EPMC6939814 | biostudies-literature
Project description:IntroductionBartonella species are increasingly recognized as agents of culture-negative endocarditis. However, to date, almost all human cases have been associated with two members of the genus, Bartonella henselae and Bartonella quintana. B. henselae infections are zoonotic, with domestic cats serving as reservoir hosts for the pathogen. Bartonella clarridgeiae also exploits cats as reservoir hosts, but its zoonotic potential is far less established.Case presentationA 34-year-old male presented with palpitations after a history of aortic incompetence. During surgery for an aortic valve replacement, two vegetations were found on the aortic valve. PCR analysis of the vegetation demonstrated the presence of Bartonella species and so the patient was treated post-operatively with ceftriaxone and doxycycline, making a good recovery. Further PCR-based analysis of the patient's aortic vegetation confirmed the presence of B. clarridgeiae .ConclusionThis report expands the number of Bartonella species associated with endocarditis and provides clear evidence that B. clarridgeiae should be considered a zoonotic pathogen.
| S-EPMC7491929 | biostudies-literature
Project description:PurposeTo compare the characteristics of reimplantation (RI) using grafts with sinuses and remodeling (RM) with/without external suture annuloplasty using a pulsatile flow simulator.MethodsPorcine aortic roots were obtained from an abattoir, and six models of RM and RI with sinuses were prepared. External suture annuloplasty (ESA) was performed in the RM models to decrease the root diameter to 22 mm (RM-AP22) and 18 mm (RM-AP18). Valve models were tested at mean pulsatile flow and aortic pressure of 5.0 L/min and 120/80 (100) mmHg, respectively, at 70 beats/min. The forward flow, regurgitation, leakage, backflow rates, valve-closing time, and mean and peak pressure gradient (p-PG) were evaluated. Root configurations were examined using micro-computed tomography (micro-CT).ResultsThe backflow rate was larger in the RM models than in the RI models (RI: 8.56% ± 0.38% vs. RM: 12.64% ± 0.79%; p < 0.01). The RM-AP and RI models were comparable in terms of the forward flow, regurgitation, backflow rates, p-PG, and valve-closing time. The analysis using a micro-CT showed a larger dilatation of the sinus of the Valsalva in the RM groups than in the RI group (Valsalva: RI, 26.55 ± 0.40 mm vs. RM-AP22, 31.22 ± 0.55 mm [p < 0.05]; RM-AP18, 31.05 ± 0.85 mm [p < 0.05]).ConclusionsRM with ESA and RI with neo-sinuses showed comparable hemodynamics. ESA to RM reduced regurgitation.
| S-EPMC10290965 | biostudies-literature
Project description:BackgroundAneurysmal degeneration of the coronary button after aortic root replacement using the button technique is a rare but potentially life-threatening complication. However, the appropriate management of this complication, including the indications for conservative and surgical treatment, is still unknown.Case presentationHere we present a 38-year-old woman who successfully underwent surgical repair of a left coronary button aneurysm using the graft interposition technique 24 years after aortic root replacement. Because follow-up computed tomography after aortic root replacement showed a progressively enlarging left coronary button aneurysm, the patient was judged an acceptable candidate for surgical treatment, considering the potential risk of aneurysmal rupture and subsequent myocardial infarction. The postoperative recovery was uneventful. The patient is doing well 1 year after the surgery.ConclusionsWe believe that serial follow-up using computed tomography is mandatory for coronary button aneurysms, and surgical intervention may be considered if progressive enlargement of the aneurysm is observed, especially in younger patients.
| S-EPMC8422648 | biostudies-literature
Project description:BackgroundThe appearance of dumbbell neuroma of the first thoracic root is extremely rare. The extradural component of a T1-dumbbell neuroma may present as an apical mass. The diagnosis of hand weakness is complex and may be delayed in T1-neuroma because of absence of the palpable cervical mass. One-stage removal of a T1-root neuroma and its intrathoracic extension demanded an extended posterior midline approach in the sitting position.Case presentationA 51-year old man had suffered a traumatic partial tendon rupture of his wrist flexor muscles 6 years ago. Since the incident he occasionally felt fullness and tenderness in the affected forearm with some tingling in his fingers bilaterally. During the last two years the hand weakness was continuous and hypotrophy of the medial flexor and intrinsic hand muscles had become apparent. Electrophysiological studies revealed an ulnar neuropathy in addition to mild median and radial nerve dysfunction, including a mild contralateral carpal tunnel syndrome. The diagnostic work-up for multiple mononeuropathy in the upper extremity was negative. Repeated electrophysiological studies revealed fibrillations in the C7 paravertebral muscles on the affected side. Chest x-ray revealed a large round apical mass on the affected side. A Horner's syndrome was noted at this point of diagnostic work-up. MRI of the cervical and thoracic spine revealed a dumbbell T1 neuroma enlarging the intervertebral foramen at T1-2 and a 5 cm large extradural tumor with extension into the apex of the ipsilateral lung. The patient underwent surgery in sitting position using a left dorsal midline approach. Although the T1 root could not be preserved, the patient's neurological condition was unchanged after the surgery.ConclusionExtended posterior midline exposure described here using hemilaminectomy, unilateral facetectomy and costo-transversectomy is efficient and safe for one-stage removal of dumbbell tumors at the T1 level with a predominantly extraforaminal component in the apex of the lung extending up to 6-7 cm laterally. Horner's syndrome, if present and observed, may significantly narrow the differential diagnosis of hand weakness caused by T1-root tumors.
| S-EPMC1831774 | biostudies-literature