Background
Due to the advances in interventional cardiology in recent years, more and more patients are currently receiving cardiac devices. Therefore, the number of patients with device-associated endocarditis are increasing. Device-associated endocarditis is a threatening disease with special diagnostic and therapeutic challenges. Interventional devices for left atrial appendage (LAA) closure have been available for several years. However, there have been very few case reports of LAA closure device-associated endocarditis.
Case summary
An 83-year-old woman presented with fever and fatigue. She had a history of permanent atrial fibrillation and recurrent bleeding on oral anticoagulation. Consequently, the patient underwent interventional LAA closure about 20 months earlier. On blood cultures grew Staphylococcus aureus. Transesophageal echocardiography revealed LAA closure device-associated a mobile, echo-dense mass which was consistent with an infectious vegetation in this clinical context. An intravenous antibiotic therapy was started, and our Heart Team recommended complete removal of the device, which the patient refused. The patient subsequently died as a result of progressive endocarditis and multiple pre-existing co-morbidities.
Conclusion
LAA occlusion device-associated endocarditis has rarely been reported. Due to the increase in LAA closure device implantation, device-associated endocarditis is expected to increase in the future. Transesophageal echocardiography is required for correct diagnosis. Our case report suggests that an infection can occur long after Implantation.
Ultrasound-accelerated thrombolysis (USAT) is an advanced interventional therapy for patients with intermediate–high-risk pulmonary embolism (PE) who deteriorated on anticoagulation or for high-risk patients for whom systemic thrombolysis is contraindicated. The aim of this study is to investigate the safety and efficacy of this therapy with a focus on the improvement of vital signs and laboratory parameters. Seventy-nine patients with intermediate–high-risk PE were treated with USAT from August 2020 to November 2022. The therapy significantly decreased the mean RV/LV ratio from 1.2 ± 0.22 to 0.9 ± 0.2 (p < 0.001) as well as the mean PAPs from 48.6 ± 11 to 30.1 ± 9.0 mmHg (p < 0.001). The respiratory and heart rate decreased significantly (p < 0.001). Serum creatinine decreased significantly from 1.0 ± 0.35 to 0.9 ± 0.3 (p < 0.001). There were 12 access-associated complications, which could be treated conservatively. One patient had haemothorax after the therapy and had to be operated on. USAT is an effective therapy for patients with intermediate–high-risk PE, with favourable hemodynamic, clinical, and laboratory outcomes.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.