Multiplane imaging: A quick way to assess prosthetic aortic valve.
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ABSTRACT:
SUBMITTER: Desai PM
PROVIDER: S-EPMC9244256 | biostudies-literature |
REPOSITORIES: biostudies-literature
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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-other
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:Transcatheter valve implantation continues to grow worldwide and has been used principally for the nonsurgical management of native aortic valvular disease-as a potentially less invasive method of valve replacement in high-risk and inoperable patients with severe aortic valve stenosis. Given the burden of valvular heart disease in the general population and the increasing numbers of patients who have had previous valve operations, we are now seeing a growing number of high-risk patients presenting with prosthetic valve stenosis, who are not potential surgical candidates. For this high-risk subset transcatheter valve delivery may be the only option. Here, we present an inoperable patient with severe, prosthetic valve aortic and mitral stenosis who was successfully treated with a trans catheter based approach, with a valve-in-valve implantation procedure of both aortic and mitral valves.
| S-EPMC4881642 | 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:This report describes a successful transcatheter aortic valve replacement in an older patient with severe aortic stenosis, mitral paravalvular leak, and associated hemolytic anemia. Transcatheter aortic valve replacement is worth considering as a first-line procedure in this high-risk patient because of its beneficial impact on reducing shear forces at the mitral valve. (Level of Difficulty: Intermediate.).
| S-EPMC8299977 | biostudies-literature
Project description:Highlights•Three-dimensional TEE adds value in diagnosing IE in bioprosthetic valves.•Bioprosthetic valve IE resolves with appropriate antibiotic therapy.•Misdiagnosis of IE can lead to inappropriate treatment and lethal complications.
| S-EPMC6058250 | biostudies-other
Project description:BackgroundTranscatheter aortic valve implantation (TAVI) has emerged as an alternative for the treatment of severe symptomatic aortic stenosis for patients at high risk for open surgery. Although experience with TAVI is increasing, few cases of post-TAVI endocarditis are reported.Case summaryWe present a case of an 87-year-old female patient who presented with fever, unresponsive to empiric antibiotics 3 months after a TAVI procedure for severe aortic valve stenosis. After some delay due to three hospitalizations in primary care hospitals, she was transferred to our general intensive care unit where the diagnosis of endocarditis due to Corynebacterium was made. The patient was transferred abroad to a specialized surgical centre of excellence and underwent aortic root and valve replacement with a homograft. After several post-operative complications the patient's condition improved and is presently satisfactory.DiscussionKeeping a high index of suspicion when evaluating patients might lead to a favourable outcome if appropriate and early intervention was implemented. Adherence to policies which address infection control and aseptic techniques when performing TAVI might lead to fewer cases of post-TAVI endocarditis.
| S-EPMC6426036 | biostudies-literature
Project description:BACKGROUND:Prosthetic valve endocarditis (PVE) is a serious complication, and it is difficult to treat marked adhesion and infectious tissue. CASE PRESENTATION:There were four patients with aortic PVE, whose ages ranged from 59 to 80?years. In all patients, transoesophageal echocardiography revealed periannular abscess formation. We applied aortic annular enlargement techniques using a composite three-layer patch to repair the defects after radical debridement of the abscesses, and then replaced the prosthetic valves on the reconstructed annuli. All patients received antibiotics after surgery and recovered well without recurrence. CONCLUSIONS:The aortic annular enlargement techniques provided a good field of vision at the complicated annulus, and our original patch was useful for repairing the aortic annulus and its surrounding apparatus.
| S-EPMC7249640 | biostudies-literature
Project description:BackgroundFatal thrombo-embolic events like cerebral stroke or myocardial infarction are rare complications of prosthetic heart valve leaflet thrombosis. Nevertheless, prevention and management of leaflet thrombosis is gaining increased attention, particularly with the widespread adoption of transcatheter heart valves.Case summaryWe herein present the case of a 79-year-old man who had undergone a transcatheter aortic valve implantation procedure. Seven months later, he presented with a non-ST-segment elevation myocardial infarction. Coronary angiography did not reveal obstructive lesions. A dedicated cardiac computed tomography scan showed thrombosis of both right- and non-coronary leaflets of the prosthetic aortic valve, while prosthetic valve function was normal on echocardiography. Transmural myocardial infarction lesions in the midventricular and apical inferior wall were detected by cardiac magnetic resonance imaging.DiscussionSubclinical leaflet thrombosis of prosthetic aortic valves is a common finding. In this case report, we show that myocardial infarction presumably due to leaflet thrombosis was the first symptom in an otherwise asymptomatic patient. This finding raises the question of the validity in distinguishing between subclinical and clinical leaflet thrombosis based on prosthetic valve function.
| S-EPMC7793162 | biostudies-literature
Project description:Introductionand importance: For treatment of prosthetic valve endocarditis (PVE), redo-aortic valve replacement (AVR) is usually required. However, the recurrence of PVE continues to be a serious problem that needs a solution.Case presentationAn 83-year-old woman who had undergone AVR for aortic infective endocarditis 12 years ago was diagnosed with PVE complicated with acute cerebral infarction. Urgent redo-AVR was performed. After complete removal of the prosthesis, Perceval S valve was implanted successfully. There were no postoperative neurological deteriorations, and the echocardiogram showed no recurrence of PVE.Clinical discussionTheoretically, the fewer prostheses left in the heart, the lower the risk of PVE recurrence.ConclusionIn patients with PVE, redo-AVR using the Perceval valve may be a suitable option since Perceval reduces the prosthesis in the heart compared with conventional redo-AVR.
| S-EPMC8091893 | biostudies-literature