Challenge in the management of infective endocarditis with multiple valvular involvement

Araújo, Izabella Rodrigues de; Nunes, Maria do Carmo Pereira; Gelape, Cláudio Léo; Carvalho, Vinicius Tostes; Lacerda, Benone Evaristo Rezende Araújo; Oliveira, Gustavo Brandão de; Brant, Luiza Caldeira; Ferrari, Teresa Cristina Abreu

doi:10.1590/s0037-86822012000200028

Cited by 6 publications

(2 citation statements)

References 10 publications

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“…Right-sided IE accounts for 5-10 % of cases of IE [19], and it may occur in patients with a permanent pacemaker, implantable cardioverter defibrillator, CVC, or congenital heart disease, although this situation is more common in IVDAs [24]. Among the pathophysiological hypotheses that support the incidence of right-sided IE in IVDAs are abnormalities on the immune system, contaminated drug solutions and reduced injection hygiene [25].…”

Section: Introductionmentioning

confidence: 99%

Infective endocarditis in intravenous drug abusers: an update

Sousa

Botelho

Rodrigues

et al. 2012

Eur J Clin Microbiol Infect Dis

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Infective endocarditis despite advances in diagnosis remains a common cause of hospitalization, with high morbidity and mortality rates. Through literature review it is possible to conclude that polymicrobial endocarditis occurs mainly in intravenous drug abusers with predominance in the right side of the heart, often with tricuspid valve involvement. This fact can be associated with the type of drug used by the patients; therefore, knowledge of the patient's history is critical for adjustment of the therapy. It is also important to emphasize that the most common combinations of organisms in polymicrobial infective endocarditis are: Staphylococcus aureus, Streptococcus pneumonia and Pseudomonas aeruginosa, as well as mixed cultures of Candida spp. and bacteria. A better understanding of the epidemiology and associated risk factors are required in order to develop an efficient therapy, although PE studies are difficult to perform due to the rarity of cases and lack of prospective cohorts.

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Section: Introductionmentioning

confidence: 99%

Infective endocarditis in intravenous drug abusers: an update

Sousa

Botelho

Rodrigues

et al. 2012

Eur J Clin Microbiol Infect Dis

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“…As a matter of interest, one of our patients had a combined pulmonary and aortic valves IE. That is a very uncommon pathology [17,18] de Araújo [19] reported the case of aortic and pulmonary IE in a patient who was diagnosed as having VSD as well. It may be suggested that the presence of VSD was a very important factor for the etiology and pathogenesis because turbulent shunt flow could cause damage to the pulmonary valve endothelium.…”

Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Infective Endocarditis in Pulmonary Position—15 Years Single Centre Experience

et al. 2019

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Background and Objectives: Infective endocarditis in the pulmonary position is a rare disease. Isolated pulmonary valve endocarditis is extremely rare. The aim of our study was to assess patients who were treated surgically for pulmonary endocarditis at our institution from January 2003 to December 2017. Materials and Methods: We analyze eight cases of infectious endocarditis in pulmonary position out of 293 patients who were operated for infective endocarditis (2.7%, 8/293). Only two of these eight patients were not related to congenital heart malformation. They were followed for early and late mortality, long-term survival, postoperative morbidity and reoperations. Results: Among six patients suffering from congenital heart disease, four patients underwent corrections of pulmonary valve malformation previously, and their infected grafts were replaced by two allografts and two xenografts. The two other patients had replaced their infected pulmonary valves with allografts. Two non-congenital patients with pulmonary valve endocarditis underwent valve replacement with biological prosthesis. All patients survived the early postoperative course. The mean follow-up time was 9.1 (interquartile range (IQR), 5.3–12.6) years. The long-term follow-up included seven patients. One patient (12.5%, 1/8) died more than 4 years after the surgery due to sepsis. Pulmonary endocarditis was the rarest endocarditis treated surgically (p < 0.001). Conclusion: Surgery for infective endocarditis in the pulmonary position (IEPP) is an effective method of treatment with excellent early outcome and good late results despite a very uncommon pathology and few operations being performed. Surgery performed earlier may make the procedure less radical.

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Pseudoaneurysm of the mitral–aortic intervalvular fibrosa

Şahan¹,

Gül²,

Şahan³

et al. 2014

Herz

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Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (P-MAIVF) is an infrequent but potentially life-threatening condition. Both transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) can detect P-MAIVF with sensitivity rates of 43 and 90 %, respectively. The typical finding of echocardiography is a pulsatile echo-free sac that expands in systole and collapses in diastole. Our review comprises 166 patients with P-MAIVF, including eight cases in our hospital and 158 cases from the literature. P-MAIVF is often associated with infection or surgical trauma. While it is likely to maintain an asymptomatic course, symptoms of shortness of breath, heart failure, valvular disease, chest pain, endocarditis, and cerebrovascular events are common clinical presentations. The recommended treatment is surgery. However, conservative therapy is an alternative approach for high-risk patients or when surgical treatment is refused. With the increasing incidence of cardiac surgery and infective endocarditis, a likely increment in the new diagnosis of pseudoaneurysm is expected.

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Challenge in the management of infective endocarditis with multiple valvular involvement

Cited by 6 publications

References 10 publications

Infective endocarditis in intravenous drug abusers: an update

Infective endocarditis in intravenous drug abusers: an update

Surgical Treatment of Infective Endocarditis in Pulmonary Position—15 Years Single Centre Experience

Pseudoaneurysm of the mitral–aortic intervalvular fibrosa

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