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A rare case of anaerobic streptococci endocarditis in a young female with bicuspid aortic valve: case report.

ABSTRACT:

Background

Bicuspid aortic valve is the most common congenital cardiovascular malformation and occurs in 1-2% of the population. The haemodynamic changes appear early, leading to tissue damage and predisposing to germs attachment. The development of perivalvular extension is a constant in bicuspid aortic valve endocarditis. Infective endocarditis with anaerobic bacteria is a rare condition with a high rate of mortality.

Case summary

We report a case of a young female with bicuspid aortic valve infective endocarditis. Involved bacteria were anaerobic streptococci, and the clinical course of the diseases was very aggressive. The echocardiographic evaluation revealed aortic and mitral regurgitation, perivalvular abscess, ventricular septum defect, and pericardial effusion. The surgery approach consisted of the aortic valve replacement with a mechanical prosthesis after radical resection of aortic root abscess and reconstruction of the annulus. The ventricular septum defect was also closed with a pericardial patch. Anticoagulation started the first day after surgery. The patient was received antibiotic therapy for 10 days before and 4 weeks after surgical intervention. Evolution was very good at 1 and 6 months follow-up.

Discussion

This is a severe case of endocarditis, complicated with extensive valvular destruction, aortic root abscess, and fistula. Perivalvular complications are frequent in patients with bicuspid aortic valve endocarditis. The 'take away' message is that echocardiography is an essential tool for diagnosis, management, and follow-up of patients with infective endocarditis.

SUBMITTER: Toader D

PROVIDER: S-EPMC7850613 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Aortic valve endocarditis in patients with bicuspid and tricuspid aortic valves.

Project description:ObjectiveTo determine the long-term survival and rate of reoperation after surgical treatment of infective endocarditis (IE) in patients with a bicuspid aortic valve (BAV) and patients with a tricuspid aortic valve (TAV).MethodsBetween 1997 and 2017, 210 patients underwent surgical treatment for native aortic valve endocarditis, including 51 patients with BAV (24%) and 159 patients with TAV (76%). Data were obtained from the Society of Thoracic Surgeons data warehouse and hospital medical record review, supplemented with surveys and national death index data for more complete follow-up.ResultsCompared with the TAV IE group, the BAV IE group was significantly younger (42 years vs 54 years) and had lower incidence rates of hypertension, coronary artery disease, and congestive heart failure (CHF). There were no significant between-group differences in postoperative stroke, sepsis, pacemaker requirement, or in-hospital mortality (2.0% vs 4.4%). Liver disease was a risk factor for operative mortality (odds ratio [OR], 13; 95% CI, 3.3-30; P = .0002). The 10-year survival rate was 64% for the BAV group versus 46% for the TAV group (P = .0191). Significant risk factors for long-term mortality were intravenous drug use (hazard ratio [HR], 4.5; P < .0001), preoperative renal failure requiring dialysis (HR, 4.13; P < .0001), CHF (HR, 1.7; P = .04), and liver disease (HR, 2.6; P = .02). The HR for BAV was 0.67 (95% confidence interval [CI], 0.3-1.4). The 10-year postoperative cumulative incidence of reoperation was significantly higher in the BAV patients compared with the TAV patients (5.7% vs 4.5%; P = .045) with an HR of 2.4 (95% CI, 0.8-7.1; P = .11) for BAV.ConclusionsBAV patients develop IE requiring surgery at a younger age than TAV patients, but have significantly better long-term survival. Early detection of BAV is important to prevent IE and provide aggressive surgical treatment should IE occur.

| S-EPMC9390515 | biostudies-literature

Uncommon acquired Gerbode defect following extensive bicuspid aortic valve endocarditis.

Project description:Gerbode defect is a rare type of left ventricle to right atrium shunt. It is usually congenital in origin, but acquired cases are also described, mainly following infective endocarditis, valve replacement, trauma or acute myocardial infarction. We report a case of a 50-year-old man who suffered an extensive and complex infective endocarditis involving a bicuspid aortic valve, the mitral-aortic intervalvular fibrosa and the anterior leaflet of the mitral valve. After dual valve replacement and annular reconstruction, a shunt between the left ventricle and the right atrium--Gerbode defect, and a severe leak of the mitral prosthesis were detected. Reintervention was performed with successful shunt closure with an autologous pericardial patch and paravalvular leak correction. No major complications occurred denying the immediate post-surgery period and the follow-up at the first year was uneventful.

| S-EPMC3334684 | biostudies-literature

A Ruptured Mitral Valve Aneurysm as Complication of a Bicuspid Aortic Valve Endocarditis.

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

Infectious Endocarditis Caused by <i>Pseudomona aeruginosa</i> on Bicuspid Aortic Valve.

Project description:We report the case of a 53-year-old man with psoriatic arthritis, suffering from a malignant and recidivant myoepithelioma in his right axilla and arm, and undergoing two surgeries, with the last one being performed a month prior to actual admission. After the last surgery, he was admitted to hospital with fever without a source. After physical examination, laboratory tests, blood cultures and transthoracic and transesophageal echocardiography, he was diagnosed with infectious endocarditis (IE) on a bicuspid aortic valve (BAV) caused by Pseudomona aeruginosa (PA). Antibiogram-guided antibiotic therapy with meropenem and tobramicin was initiated. However, in the presence of repetitive spleen infarctions and a large vegetation, 12 days after admission, a bioprosthesis aortic valve implantation was performed. The postsurgical evolution was favorable and prolonged antibiotic course with meropenem and tobramicin was completed. The pathological anatomy and the native valve cultured confirmed an IE caused by PA. Gram-negative non-HACEK IE cases are infrequent, accounting for 1.8% of the total IE cases. PA is the second most frequent bacillus in this group, causing endocarditis more prevalently when associated with healthcare procedures rather than injectable drug use. No prior case study has identified IE caused by PA related to a BAV in the last years.

| S-EPMC9239513 | biostudies-literature

Endocarditis due to Neisseria bacilliformis in a patient with a bicuspid aortic valve.

Project description:We report a case of endocarditis due to the rod-shaped Neisseria species Neisseria bacilliformis. The phenotypic characterization of this recently characterized bacteria is difficult, and the identification requires the sequencing of the 16S rRNA gene. The resolution of the disease was complete after appropriate antibiotic therapy, and surgery was not required.

| S-EPMC2691068 | biostudies-literature

Rare GATA5 sequence variants identified in individuals with bicuspid aortic valve.

Project description:Bicuspid aortic valve (BAV) is the most common type of congenital heart disease (CHD) and has a proposed genetic etiology. BAV is categorized by cusp fusion, with right-left (R-L) cusp fusion being associated with additional CHD, and right-noncoronary cusp (R-NC) fusion being associated with aortic valve dysfunction. Loss of murine Gata5, which encodes a cardiac transcription factor, results in a partially penetrant R-NC BAV, and we hypothesize that mutations in GATA5 are associated with R-NC BAV in humans.A cohort of 78 BAV patients (50 with isolated BAV and 28 with associated aortic coarctation) was analyzed using Sanger sequencing to identify GATA5 sequence variants. Biochemical assays were performed to identify functional deficits of identified sequence variants.We identified two rare heterozygous nonsynonymous variants, p.Gln3Arg and p.Leu233Pro, for a frequency of 2.6% (2/78). Both individuals with nonsynonymous variants had BAV and aortic coarctation, one R-L and one R-NC subtype. Of the nonsynonymous variants, only p.Gln3Arg demonstrated decreased transcriptional activity in vitro.Rare sequence variants in GATA5 are associated with human BAV. Our findings suggest a genotype-phenotype correlation in regards to associated CHD but not cusp fusion.

| S-EPMC5717758 | biostudies-literature

Transcatheter aortic valve implantation for patient with non-calcified bicuspid aortic valve: a case report.

Project description:BackgroundNon-calcified aortic stenosis (AS) is rare and is associated with a high risk of transcatheter valve embolization and migration (TVEM) because aortic valve complex calcification is important for stable anchoring of the prosthesis. Therefore, transcatheter aortic valve implantation (TAVI) for non-calcified AS is not preferred. However, a universally accepted strategy for TAVI in such patients is not yet established.Case summaryA 69-year-old woman with symptomatic severe AS and a high surgical risk was admitted to our institution for TAVI. Pre-procedural computed tomography (CT) revealed a non-calcified bicuspid aortic valve. Implantation of a 23 mm self-expandable valve (SEV) was planned according to the manufacturer's recommended optimal size based on CT measurements. Intraoperatively, the 23 mm SEV did not snugly fit at the aortic apparatus level. Thus, we deployed a 26 mm SEV with stable anchoring because of the stronger radial force. She was discharged without any complication. Echocardiography at 3 months follow-up showed a well-functioning transcatheter heart valve (THV) without migration or paravalvular leakage.DiscussionIn our patient with non-calcified bicuspid AS, an SEV that was one size larger than the optimal as measured on CT was successfully implanted without THV embolization. An upsized SEV may be considered when performing TAVI in patients with severe non-calcified AS.

| S-EPMC9933938 | biostudies-literature

Bicuspid reconstruction surgery in a patient suffering from aortic valve infective endocarditis with annular abscess using Ozaki's procedure: A case report.

Project description:IntroductionAortic valve infective endocarditis with annular abscess is associated with high mortality rate and surgery is usually the choice of treatment. Plasty or reconstruction of aortic valve is being performed more widely.Presentation of caseWe report a case study of a 56-year-old male who was diagnosed with congenital bicuspid aortic valve, severe aortic stenosis and regurgitation, and annular abscess. This patient underwent operation in december 2019 and Ozaki's procedure was used to measure the distance between two commissures to reconstruct new leaflets and close the abscess using autologous pericardium. A bicuspid valve was reconstructed based on the anatomical feature of the patient. 6 months after surgery, aortic valve function was good with no residual insufficiency, maximum gradient was 8 mmHg.DiscussionReconstruction of aortic valve by Ozaki's procedure has been reported with many advantages for the patient. In case of infectious endocarditis, this technique helps avoid the use of artificial materials. Bicuspid aortic valve reconstruction surgery following the novel methods of reconstructing three leaflets or maintaining the bicuspid morphology could both be performed with good results.ConclusionReconstruction of aortic valve by Ozaki's procedure in infectious endocarditis has good results. In case of true bicuspid aortic valve, reconstruction bi-leaflets can be performed.

| S-EPMC7566199 | biostudies-literature

MiR-145 expression and rare NOTCH1 variants in bicuspid aortic valve-associated aortopathy.

Project description:MicroRNAs (miRNAs) may serve as elegant tool to improve risk stratification in bicuspid aortic valve (BAV)-associated aortopathy. However, the exact pathogenetic pathway by which miRNAs impact aortopathy progression is unknown. Herewith, we aimed to analyze the association between circulating miRNAs and rare variants of aortopathy-related genes. 63 BAV patients (mean age 47.3±11.3 years, 92% male) with a root dilatation phenotype, who underwent aortic valve+/-proximal aortic surgery at a single institution (mean post-AVR follow-up 10.3±6.9 years) were analyzed. A custom-made HaloPlex HS panel including 20 aortopathy-related genes was used for the genetic testing. miRNAs were extracted from whole blood and miRNA analysis was performed using miRNA-specific assay. Study endpoint was the association between circulating miRNAs and rare genetic variants in the aortopathy gene panel. The study cohort was divided into a subgroup with rare variants vs. a subgroup without rare variants based on the presence of rare variants in the respective genes (i.e., at least one variant present). The genetic analysis yielded n = 6 potentially and likely pathogenic rare variants within the NOTCH1 gene as being the most common finding. Univariate analysis between blood miRNAs and NOTCH1 variants revealed a significantly lower expression of miR-145 in the subgroup of patients with NOTCH1 variants vs. those without NOTCH1 variants (i.e., delta Ct 4.95±0.74 vs. delta Ct 5.57±0.78, p = 0.04). Our preliminary data demonstrate a significant association between blood miR-145 expression and the presence of rare NOTCH1 variants. This association may be indicative of a specific pathogenetic pathway in the development of genetically-triggered bicuspid aortopathy.

| S-EPMC6066209 | biostudies-literature

Characteristics and prognosis of isolated aortic valve infective endocarditis in patients with bicuspid aortic valves: a propensity matched study.

Project description:IntroductionBicuspid aortic valve (BAV) is the most common congenital heart disease with an increased risk of infective endocarditis (IE). Few data are available on isolated native BAV-IE. The aim of this study was to compare patients with tricuspid aortic valve (TAV) IE and BAV-IE in terms of characteristics, management and prognosis.Material and methodsWe included 728 consecutive patients with IE on isolated native aortic valve in 3 centres: Amiens and Marseille Hospitals in France and Salerno Hospital in Italy. We studied in hospital and long-term mortality before and after matching for age, sex and comorbidity index. Median follow-up was 67.2 [IQR: 19-120] months.ResultsOf the 728 patients, 123 (16.9%) had BAV. Compared with patients with TAV-IE, patients with BAV-IE were younger, had fewer co-morbidities and were more likely to be male. They presented more major neurological events and perivalvular complications (both p < 0.05). Early surgery (<30 days) was performed in 52% of BAV-IE cases vs. 42.8% for TAV-IE (p = 0.061). The 10-year survival rate was 74 ± 5% in BAV-IE patients compared with 66 ± 2% in TAV-IE patients (p = 0.047). After propensity score matching (for age, gender and comorbidities), there was no difference in mortality between the two groups, with an estimated 10-year survival of 73 ± 5% vs. 76 ± 4% respectively (p = 0.91).ConclusionBAV is a frequent finding in patients with isolated aortic valve IE and is associated with more perivalvular complications and neurological events. The differences in survival with TAV-IE are probably related to the age and comorbidity differences between these two populations.

| S-EPMC10753019 | biostudies-literature

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