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Unfortunate Accidental Twins: Two Patients with Endocarditis of a Valve-Bearing Conduit.

ABSTRACT: Background Prosthetic valve endocarditis is becoming more common because many patients live long enough to experience bacteremia, while insufficient antibiotic prophylaxis eventually leads to graft infection. Valve-bearing conduit infections are the most feared because of technical challenges. Case Description Two young patients were coincidental twins in terms of diagnosis and therapy. Both underwent complete replacement of the conduit, aortic arch prosthesis, and additional strategies to reconnect the coronary ostia and the brachiocephalic trunk. Both were discharged without significant residual problems. Conclusion Even most demanding infectious problems can be solved. Thus, surgery should not be denied.

SUBMITTER: Ostovar R

PROVIDER: S-EPMC10332900 | biostudies-literature | 2023 Jan

REPOSITORIES: biostudies-literature

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Unfortunate Accidental Twins: Two Patients with Endocarditis of a Valve-Bearing Conduit.

Ostovar Roya R Albes Johannes M JM

The Thoracic and cardiovascular surgeon reports 20230101 1

<b>Background</b> Prosthetic valve endocarditis is becoming more common because many patients live long enough to experience bacteremia, while insufficient antibiotic prophylaxis eventually leads to graft infection. Valve-bearing conduit infections are the most feared because of technical challenges. <b>Case Description</b> Two young patients were coincidental twins in terms of diagnosis and therapy. Both underwent complete replacement of the conduit, aortic arch prosthesis, and additional str ...[more]

PMID: 37434778

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Project description:Objectives: We report the first use of a biorestorative valved conduit (Xeltis pulmonary valve-XPV) in children. Based on early follow-up data the valve design was modified; we report on the comparative performance of the two designs at 12 months post-implantation. Methods: Twelve children (six male) median age 5 (2 to 12) years and weight 17 (10 to 43) kg, had implantation of the first XPV valve design (XPV-1, group 1; 16 mm (n = 5), and 18 mm (n = 7). All had had previous surgery. Based on XPV performance at 12 months, the leaflet design was modified and an additional six children (five male) with complex malformations, median age 5 (3 to 9) years, and weight 21 (14 to 29) kg underwent implantation of the new XPV (XPV-2, group 2; 18 mm in all). For both subgroups, the 12 month clinical and echocardiographic outcomes were compared. Results: All patients in both groups have completed 12 months of follow-up. All are in NYHA functional class I. Seventeen of the 18 conduits have shown no evidence of progressive stenosis, dilation or aneurysm formation. Residual gradients of >40 mm Hg were observed in three patients in group 1 due to kinking of the conduit (n = 1), and peripheral stenosis of the branch pulmonary arteries (n = 2). In group 2, one patient developed rapidly progressive stenosis of the proximal conduit anastomosis, requiring conduit replacement. Five patients in group 1 developed severe pulmonary valve regurgitation (PI) due to prolapse of valve leaflet. In contrast, only one patient in group 2 developed more than mild PI at 12 months, which was not related to leaflet prolapse. Conclusions: The XPV, a biorestorative valved conduit, demonstrated promising early clinical outcomes in humans with 17 of 18 patients being free of reintervention at 1 year. Early onset PI seen in the XPV-1 version seems to have been corrected in the XPV-2, which has led to the approval of an FDA clinical trial. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT02700100 and NCT03022708.

Project description:BackgroundRadiofrequency ablation (RFA) is the most effective non-pharmacological approach in the reduction of ventricular tachycardia (VT) recurrence. However, it is crucial to thoroughly screen every patient for contraindications for RFA and provide appropriate pharmacological prophylaxis, if needed, since adverse effects may be fatal.Case summaryA 77-year-old male with multi-vessel coronary artery disease, heart failure with reduced ejection fraction (New York Heart Association (NYHA) Class III), with implantable cardioverter-defibrillator was admitted to our clinic due to recurrent life-threatening VT. The patient presented several concomitant diseases: dyslipidaemia, hypertension, and chronic kidney disease in Stage IIIB. He had a history of two myocardial infarctions and coronary artery bypass grafts complicated by mediastinitis and dehiscence of a sternotomy scar (2013). Radiofrequency ablation and pace mapping of VT were performed in sterile conditions, but no pre-operative antibiotic prophylaxis was administered. There were no local or general complications in the post-operative period. The patient was discharged from the clinic in good condition. A week later, the patient suffered from septic shock and infective endocarditis of mitral valve complicated with infiltration of the ventricular septum, wall dissection of the left ventricle (LV), pseudoaneurysm, and abscess of the LV. At the time of the second hospitalization extensive dental carries were found and oral cavity sanitation was performed. Due to the severity of the condition, patient did not survive.ConclusionOral cavity infections are common but often overlooked, mainly when the RFA procedure is urgent. A thorough physical examination, including a dental check-up, is crucial to minimize the risk of potential infection of the endocardial tissue and maximize the benefits of the therapy. Still, it is possible that the myocardial infection was not a result of oral cavity infection but a result of other undiagnosed and untreated infection. Contamination of the procedure site with patients' own microbiota or foreign microorganisms by the medical personnel is also a likely and unfortunate scenario. The presented case highlights the significance of not only prophylaxis, screening, and treatment of possible inflammation sites before RFA but also the need for sustaining sanitary standards and sterile conditions.

Dataset Information

Unfortunate Accidental Twins: Two Patients with Endocarditis of a Valve-Bearing Conduit.

Publications

Unfortunate Accidental Twins: Two Patients with Endocarditis of a Valve-Bearing Conduit.

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