Challenges in Infective Endocarditis

Abstract

Infective endocarditis is defined by a focus of infection within the heart and is a feared disease across the field of cardiology. It is frequently acquired in the health care setting, and more than one-half of cases now occur in patients without known heart disease. Despite optimal care, mortality approaches 30% at 1 year. The challenges posed by infective endocarditis are significant. It is heterogeneous in etiology, clinical manifestations, and course. Staphylococcus aureus, which has become the predominant causative organism in the developed world, leads to an aggressive form of the disease, often in vulnerable or elderly patient populations. There is a lack of research infrastructure and funding, with few randomized controlled trials to guide practice. Longstanding controversies such as the timing of surgery or the role of antibiotic prophylaxis have not been resolved. The present article reviews the challenges posed by infective endocarditis and outlines current and future strategies to limit its impact.

Prosthetic valve endocarditis after transcatheter aortic valve replacement: A case report and current review

“…The attachment of these microorganisms cells to cells within the embedded self-produced matrix of extracellular polymeric substance creates a biofilm which allows them to evade the host immune response. [5] Furthermore, the space between the bioprosthesis and the native valve cusp may be a suitable nest for pathogen accumulation during transient bacteremia. PVE after TAVR has been reported in both balloon-expandable (Edwards SAPIEN, Edwards Lifesciences Inc, Irvine, CA) and self-expandable (CoreValve, Medtronic, Minneapolis, MN) valves.…”

Systemic Embolization from an Unusual Intracardiac Mass in the Left Ventricular Outflow Tract

“…Additionally, she had acute heart failure due to severe aortic valve insufficiency. The objective of surgery is to remove infected tissue, foreign material, and hardware; clear and debride paravalvular infection and cavities; restore cardiac integrity and valve function; and remove threatening sources of emboli [3]. It is imperative that she abstains from recreational intravenous drug use in the future to avoid a repeat episode of infective endocarditis.…”

“…Transesophageal echocardiography (TEE) is the imaging modality of choice due to the proximity of the interface between the probe and the heart producing a high sensitivity and specificity [1–5]. TEE can also better identify complications related to masses including abscesses and fistulae [3, 4]. Other potentially useful imaging modalities include cardiac magnetic resonance, cardiac computed tomography, and cardiac positron emission topography [2, 3].…”

“…TEE can also better identify complications related to masses including abscesses and fistulae [3, 4]. Other potentially useful imaging modalities include cardiac magnetic resonance, cardiac computed tomography, and cardiac positron emission topography [2, 3]. Once appropriate imaging and diagnosis have been obtained, an appropriate plan of action can be undertaken; for example, cardiac surgery may be indicated in select cases of infective endocarditis.…”

The round table approach in infective endocarditis & cardiovascular implantable electronic devices infections: make your e-Team come true

“…Its success is contingent upon Bknowledge of one's own area as well as other team members' disciplines, flexibility of roles, and comfort and skill in supplying and receiving education between the disciplines^ [7]. To promote effective collaboration, the team must address issues of group dynamics, including role clarification, team unity, communication, and patterns of decision-making and leadership, as underlined recently [8,9]. A communication framework, which supports and ensures interactive participation from all relevant team members at regular clinical meetings needs to be established to achieve integrated diagnostic-therapeutic strategies (using the current guidelines), (inter)national registries, organized follow-up of the patients, and control by training & certification (Fig.…”