Clinical, Radiographic, and Microbiologic Features of Infective Endocarditis in Patients With Hypertrophic Cardiomyopathy

Sims, Jason R.; Anavekar, Nandan S.; Bhatia, Subir; O’Horo, John C.; Chandrasekaran, Krishnaswamy; Wilson, Walter R.; Baddour, Larry M.; Gersh, Bernard J.; DeSimone, Daniel C.

doi:10.1016/j.amjcard.2017.11.010

Cited by 15 publications

(16 citation statements)

References 30 publications

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“…Antibiotic prophylaxis is usually limited to high-risk patients, such as individuals with a history of IE, prosthetic valve, and unrepaired cyanotic CHD undergoing dental procedure [5]. Surprisingly, left ventricular outflow tract obstruction in HOCM is not a risk factor, as similar rates of aortic and mitral valve involvement occur in patients with or without LVOT obstruction [6-7]. In patients with HOCM, the mitral valve is the most common valve affected due to elongated leaflets and continued erosion due to turbulent flow.…”

Section: Discussionmentioning

confidence: 99%

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Streptococcus viridans Endocarditis Affecting All Four Valves

Kumar

Anstadt

Lia

et al. 2019

Cureus

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Infective endocarditis (IE) affecting all four valves is rare. We describe an interesting clinical scenario of a 47-year-old female, with an underlying, unrepaired atrial septal defect (ASD) and hypertrophic obstructive cardiomyopathy (HOCM), who presented with a five-week history of worsening lower extremity rash and New York Heart Association (NYHA) class IV symptoms. She was febrile to 101.3°F at the time of presentation. Examination revealed dental caries and track mark on hands. Her extremities demonstrated palpable purpura and pitting edema. Chest auscultation revealed bibasilar crackles and a grade III pan-systolic murmur, best heard over the apex, with radiation to the axilla. The blood gram stain resulted positive for gram-positive cocci in chains, prompting the initiation of ceftriaxone. Transthoracic echocardiography (TTE) did not reveal any new valvular regurgitation or vegetation. Transesophageal echocardiography (TEE) showed vegetation on all four valves and underlying ASD with HOCM. Blood cultures grew Streptococcus viridians. She had evidence of extensive septic emboli to the brain, lungs, spleen, and intestines. Given the extent of valvular involvement, intracranial hemorrhage, and tenuous hemodynamic status, a decision was taken to manage her conservatively followed by elective surgical management. She, however, went into cardiogenic shock further complicated by lower gastrointestinal bleed and passed away.

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Section: Discussionmentioning

confidence: 99%

“…In patients with HOCM, the mitral valve is the most common valve affected due to elongated leaflets and continued erosion due to turbulent flow. Hence, these patients are at increased risk of persistent sepsis and heart failure [6,8]. Congenital heart disease usually predisposes to right-sided valvular involvement [7].…”

Section: Discussionmentioning

confidence: 99%

Streptococcus viridans Endocarditis Affecting All Four Valves

Kumar

Anstadt

Lia

et al. 2019

Cureus

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“…There is overall conflicting data, with some studies finding IE is related to LVOT gradient and a propensity for MV infection, whilst other studies have found the contrary, with no particular relation to LVOT gradient or predilection for AV or MV [67].…”

Section: Echocardiographic Diagnosis and Predictors Of Endocarditis Riskmentioning

confidence: 95%

The Role of Modern-Era Echocardiography in Identification of Cardiac Risk Factors for Infective Endocarditis

Sedgwick¹,

Scalia²

2018

Advanced Concepts in Endocarditis

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This chapter provides an updated overview of the scientific literature on cardiac pathology predisposing to infective endocarditis and the estimated risk associated with selected lesion-specific abnormalities, in an era of changing epidemiology and advanced echocardiographic imaging. Importantly, with the evolution of modern-era echo, subtle changes in valve structure and function are now easily detectable and a proportion of cases of apparently 'normal' valves involved with IE, may in fact have subtle pre-existing pathological and/or haemodynamic abnormalities. The chapter will have a clinical focus with an aim to provide the Physician with up-to-date and practical information on cardiac risk factor identification for infective endocarditis.

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“…Although the literature contains case reports and small series describing this rare manifestation of IE in adults with HCM, [3][4][5] this case (Video 1) highlights that in the current era pediatric patients with HCM are also at risk for IE and that timely surgical intervention can effectively treat both pathologies simultaneously.…”

Section: Central Messagementioning

confidence: 97%

A rare pediatric case of left ventricular outflow tract infective endocarditis in hypertrophic cardiomyopathy

et al. 2020

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Video clip is available online.Infective endocarditis (IE) is a rare complication in adults with hypertrophic cardiomyopathy (HCM)-incidence of 1.4 to 3.8 per 1000 person-years-most commonly involving the mitral valve. 1,2 Although infrequent, HCM patients are at increased risk of developing IE with or without left ventricular outflow obstruction (LVOTO). 1,3 The true incidence of IE is unknown in children with HCM. We report an unusual case of a 15-year-old girl with HCM and severe LVOTO, who developed IE within the LVOT/subaortic region. Due to systemic embolization and persistent fever, she underwent surgical intervention to address both IE and pre-existing LVOTO. Consent to publish was obtained from the patient's parents.The patient was diagnosed with HCM, trivial aortic insufficiency (AI), and mild LVOTO at age 11 years. Her FIGURE 1. Comparison of transesophageal echocardiograph with hypertrophic cardiomyopathy and infectious endocarditis. A, Preoperative showing subaortic vegetation in left ventricular outflow tract (red dotted arrow) and severe septal hypertrophy. B, Postoperative showing excision of vegetation and improved patency of the left ventricular outflow tract. The interventricular septum (white solid arrow) is thickened after septal myectomy. MV, Mitral valve; LA, left atrium; AV, aortic valve; Ao, aorta; IVS, interventricular septum.

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Clinical, Radiographic, and Microbiologic Features of Infective Endocarditis in Patients With Hypertrophic Cardiomyopathy

Cited by 15 publications

References 30 publications

Streptococcus viridans Endocarditis Affecting All Four Valves

Streptococcus viridans Endocarditis Affecting All Four Valves

The Role of Modern-Era Echocardiography in Identification of Cardiac Risk Factors for Infective Endocarditis

A rare pediatric case of left ventricular outflow tract infective endocarditis in hypertrophic cardiomyopathy

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