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BMJ Case Reports Aug 2019A 62-year-old man was admitted to the emergency department due to fever and acute heart failure. A transthoracic echocardiogram revealed severe aortic valve obstruction....
A 62-year-old man was admitted to the emergency department due to fever and acute heart failure. A transthoracic echocardiogram revealed severe aortic valve obstruction. He was an hepatic transplant recipient and was medicated with everolimus. He underwent mitral and aortic valve replacement with prosthetic valves 4 years ago. Due to his medical background, therapy and clinical presentation, empirical therapy for infective endocarditis was started. Transoesophageal echocardiogram showed severe aortic valve regurgitation but no other findings suggestive of endocarditis. Computed tomography (CT) revealed pulmonary infiltrates compatible with infection and no evidence of septic embolisation. Multiple sets of blood cultures were negative. was isolated in bronchial lavage and antibiotic therapy was adjusted. The patient underwent aortic valve replacement, with no macroscopic findings suggestive of endocarditis. was isolated in the surgically removed valve. Dual antibiotic therapy was successfully administered for 6 weeks.
Topics: Acute Disease; Anti-Bacterial Agents; Aortic Valve Insufficiency; Bronchoalveolar Lavage Fluid; Bronchoscopy; Diagnosis, Differential; Echocardiography, Transesophageal; Endocarditis, Bacterial; Heart Failure; Heart Valve Diseases; Heart Valve Prosthesis; Humans; Lung; Male; Middle Aged; Proteus mirabilis; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 31466989
DOI: 10.1136/bcr-2019-230575 -
Cardiovascular Revascularization... Mar 2020Coronary embolism is a rare and potentially fatal phenomenon that occurs primarily in patients with valvular heart disease and atrial fibrillation. There is a lack of... (Review)
Review
BACKGROUND
Coronary embolism is a rare and potentially fatal phenomenon that occurs primarily in patients with valvular heart disease and atrial fibrillation. There is a lack of consensus regarding the diagnosis, treatment, and management of coronary embolism, leaving management at the discretion of the treating physician. Through this review, we aim to establish a better understanding of coronary embolism, and to identify treatment options - invasive and non-invasive - that may be used to manage coronary embolism.
METHODS AND RESULTS
Our systematic review included 147 documented cases of coronary embolism from case reports and case series. The average age of our population was 54.2 ± 17.6 years. The most common causes of coronary embolism included infective endocarditis (22.4%), atrial fibrillation (17.0%), and prosthetic heart valve thrombosis (16.3%). Initial presentation was indistinguishable from an acute coronary syndrome (ACS) due to coronary atherosclerosis, and the diagnosis required a high level of suspicion and evaluation with angiography. Treatment strategies included, but were not limited to, thrombectomy, thrombolysis, balloon angioplasty and stent placement. Myocardial dysfunction on echocardiography was observed in over 80% of patients following coronary embolism. "Good outcomes" were reported in 68.7% of case reports and case series, with a mortality rate of 12.9%.
CONCLUSION
Coronary embolism is an under-recognized etiology of myocardial infarction with the potential for significant morbidity and mortality. To improve outcomes, physicians should strive for early diagnosis and intervention based on the underlying etiology. Thrombectomy may be considered with the goal of rapid restoration of coronary flow.
Topics: Adult; Aged; Atrial Fibrillation; Coronary Angiography; Coronary Artery Disease; Embolism; Endocarditis, Bacterial; Heart Valve Diseases; Heart Valve Prosthesis; Humans; Middle Aged; Thrombosis
PubMed: 31178350
DOI: 10.1016/j.carrev.2019.05.012 -
Catheterization and Cardiovascular... Feb 2022Prosthetic valve endocarditis (PVE) following transcatheter aortic valve replacement (TAVR) in low surgical risk patients is uncommon, occurring in 11 of 396 patients...
Prosthetic valve endocarditis (PVE) following transcatheter aortic valve replacement (TAVR) in low surgical risk patients is uncommon, occurring in 11 of 396 patients (2.8%) in the study by Medranda et al., but associated with high morbidity (6 of 11 with embolic strokes [55%]) and mortality (2 of 11 [18%]). As TAVR volumes increase, especially in low surgical risk patients, whose long-term outcomes are generally excellent, PVE will become an increasingly important concern. Future research is needed to identify optimal strategies for prevention, diagnosis, and treatment of PVE associated with TAVR.
Topics: Endocarditis; Endocarditis, Bacterial; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 35235689
DOI: 10.1002/ccd.30126 -
Kyobu Geka. the Japanese Journal of... Sep 2021With increasing number of patients undergoing aortic valve replacement, many patients are at risk for redo aortic valve surgery. It has been reported that 56.2% of the... (Review)
Review
With increasing number of patients undergoing aortic valve replacement, many patients are at risk for redo aortic valve surgery. It has been reported that 56.2% of the patients receiving a bioprostheis and 7.4% of the patients receiving a mechanical valve need reoperation 20 years after the primary surgery. Although valve in valve transcatheter aortic valve implantation (TAVI) is a less invasive approach, redo aortic valve replacement is preferred for patients with prosthetic valve endocarditis, small aortic valve prosthesis and poor access for TAVI. Special care should be prepared for safe re-sternotomy, cardiopulmonary bypass management and strategy for cardioplegia. As reported from high volume centers, redo aortic valve replacement could be performed at a similar mortality rate as the primary surgery. New prostheses such as sutureless valve and rapid deployment valve could be useful, as well as minimally invasive cardiac surgery approach, which may prevent tissue injury. However, redo aortic valve replacement via re-sternotomy remains a gold standard. Techniques and strategy for redo aortic valve replacement are reviewed.
Topics: Aortic Valve; Aortic Valve Stenosis; Endocarditis, Bacterial; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Reoperation; Retrospective Studies; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 34548439
DOI: No ID Found -
Journal of Cardiac Surgery Jan 2021Aortic valve replacement is the definitive management for severe aortic stenosis. Intraoperatively, an aortic root enlargement (ARE) may be used to facilitate the... (Review)
Review
Aortic valve replacement is the definitive management for severe aortic stenosis. Intraoperatively, an aortic root enlargement (ARE) may be used to facilitate the implementation of a suitably sized prosthetic valve. This is to prevent patient prosthesis mismatch (PPM), a condition that causes a left ventricular outflow obstruction. There are four main techniques that are used to perform ARE, namely, Nicks, Manouguian, Nunez (modified Manouguian), and Kanno-Rastan procedures. They each involve incisions through different anatomical structures and allow a variety of valve sizes to be implanted. Studies prove that ARE effectively reduces the incidence of PPM. In addition, they show that there is no definitive link between ARE and perioperative mortality or other complications. There is a scarcity of literature exploring the comparative outcomes of each surgical technique. Therefore, further research is warranted for these procedures to be compared adequately. This review aims to summarise the available literature surrounding ARE with respect to three main questions. (1) What are the indications for ARE, (2) what surgical techniques exist to facilitate ARE, and (3) are there significant differences in patient outcomes when these surgical techniques are employed?
Topics: Aortic Valve; Aortic Valve Stenosis; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Treatment Outcome; Ventricular Outflow Obstruction
PubMed: 33124077
DOI: 10.1111/jocs.15175 -
Journal of Cardiothoracic and Vascular... Apr 2023Infective endocarditis is a common pathology routinely encountered by perioperative physicians. There has been a need for a comprehensive review of this important topic.... (Review)
Review
Infective endocarditis is a common pathology routinely encountered by perioperative physicians. There has been a need for a comprehensive review of this important topic. In this expert review, the authors discuss in detail the incidence, etiology, definition, microbiology, and trends of infective endocarditis. The authors discuss the clinical and imaging criteria for diagnosing infective endocarditis and the perioperative considerations for the same. Other imaging modalities to evaluate infective endocarditis also are discussed. Furthermore, the authors describe in detail the clinical risk scores that are used for determining clinical prognostic criteria and how they are tied to the current societal guidelines. Knowledge about native and prosthetic valve endocarditis, with emphasis on the timing of surgical intervention-focused surgical approaches and analysis of current outcomes, are critical to managing such patients, especially high-risk patients like those with heart failure, patients with intravenous drug abuse, and with internal pacemakers and defibrillators in situ. And lastly, with the advancement of percutaneous transcatheter valves becoming a norm for the management of various valvular pathologies, the authors discuss an in-depth review of transcatheter valve endocarditis with a focus on its incidence, the timing of surgical interventions, outcome data, and management of high-risk patients.
Topics: Humans; Endocarditis, Bacterial; Heart Valve Prosthesis; Endocarditis; Heart Failure; Risk Factors
PubMed: 36725476
DOI: 10.1053/j.jvca.2022.12.030 -
Progress in Cardiovascular Diseases 2022Acquired valvular heart disease is associated with increased mortality and morbidity. While the etiology of the valvular dysfunction determines the mode of treatment,... (Review)
Review
Acquired valvular heart disease is associated with increased mortality and morbidity. While the etiology of the valvular dysfunction determines the mode of treatment, over 100,000 valve operations are performed annually in the US with the use of bioprosthetic valves comprising up to 90%. While bioprosthetic valves do not require life long anticoagulation, the incidence of prosthetic valve thrombosis is continuously increasing. This article reviews the current status on diagnosis, treatment modalities and management of bioprosthetic valve thrombosis.
Topics: Aortic Valve; Bioprosthesis; Heart Valve Diseases; Heart Valve Prosthesis; Humans; Thrombosis
PubMed: 35764124
DOI: 10.1016/j.pcad.2022.06.008 -
Progress in Cardiovascular Diseases 2022
Topics: Aortic Valve; Heart Valve Prosthesis; Humans
PubMed: 35691606
DOI: 10.1016/j.pcad.2022.06.002 -
Current Cardiology Reviews 2022Paravalvular Leak (PVL) refers to the retrograde flow of blood in the space between an implanted cardiac valve and native tissue. These are unfortunately but luckily...
BACKGROUND
Paravalvular Leak (PVL) refers to the retrograde flow of blood in the space between an implanted cardiac valve and native tissue. These are unfortunately but luckily relatively uncommon complications of prosthetic valve replacement that, especially when moderate or severe, have important clinical consequences.
OBJECTIVE
Addressing PVL requires a multidisciplinary team to properly diagnose this process and choose the corrective option most likely to result in success.
METHODS
A comprehensive literature search was undertaken to formulate this narrative review.
RESULTS
This review highlights the complex nature of PVL and the promising contemporary treatments available.
CONCLUSION
Clinicians should be adept at recognizing PVL and characterizing it using multimodality imaging. Using the many available tools and a multidisciplinary approach should lead to favorable outcomes in patients with PVL.
Topics: Humans; Aortic Valve; Aortic Valve Insufficiency; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Retrospective Studies; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 35546743
DOI: 10.2174/1573403X18666220511113310 -
The Journal of Thoracic and... Apr 2023Intrinsic risk of infection of cryopreserved allograft aortic root replacements remains poorly understood despite their long history of use. The objective of this study...
OBJECTIVE
Intrinsic risk of infection of cryopreserved allograft aortic root replacements remains poorly understood despite their long history of use. The objective of this study was to determine this intrinsic risk of allograft infection and its risk factors when allografts are implanted for both nonendocarditis indications and infective endocarditis.
METHODS
From January 1987 to January 2017, 2042 patients received 2110 allograft aortic valves at a quaternary medical center, 1124 (53%) for nonendocarditis indications and 986 (47%) for endocarditis indications (670 [68%] prosthetic valve endocarditis). Staphylococcus aureus caused 193 of 949 cases of endocarditis (20%), 71 (7.3%) in persons who injected drugs. Periodic surveillance and cross-sectional follow-up achieved 85% of possible follow-up time. The primary end point was allograft infection in patients with nonendocarditis and endocarditis indications. Risk factors were identified by hazard function decomposition and machine learning.
RESULTS
During follow-up, 30 allografts (26 explanted) became infected in patients in the nonendocarditis group and 49 (41 explanted) in patients with endocarditis. At 20 years, the probability of allograft infection was 5.6% in patients in the nonendocarditis group and 14% in patients with endocarditis. Risk factors for allograft infection in patients in the nonendocarditis group were younger patient age and older donor age. Risk factors for allograft infection in patients with endocarditis were earlier implant year, injection drug use, and younger age. In patients with endocarditis, 18% of allograft infections were caused by the original organism.
CONCLUSIONS
The low infection rates, both in patients without and with endocarditis, support continued use of allografts in the modern era, in particular for the treatment of invasive endocarditis of the aortic root.
Topics: Humans; Endocarditis, Bacterial; Cross-Sectional Studies; Heart Valve Prosthesis; Endocarditis; Allografts
PubMed: 34366128
DOI: 10.1016/j.jtcvs.2021.04.086