Infective Endocarditis of the Systemic Venous Baffle Following the Atrial Switch Procedure in an Adult.
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ABSTRACT:
SUBMITTER: Finch W
PROVIDER: S-EPMC6058223 | biostudies-literature | 2017 Jun
REPOSITORIES: biostudies-literature
Publications
Infective Endocarditis of the Systemic Venous Baffle Following the Atrial Switch Procedure in an Adult.
Finch William W Sanchez Daniel R DR Cho David D Soverow Jonathan J Shantouf Ronney R
CASE (Philadelphia, Pa.) 20170527 3
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Project description:In humans, one of the major factors associated with infective endocarditis (IE) is the concurrent presence of periodontal disease (PD). However, in veterinary medicine, the relevance of PD in the evolution of dogs' endocarditis remains poorly understood. In order to try to establish a correlation between mouth-associated Enterococcus spp. and infective endocarditis in dogs, the present study evaluated the presence and diversity of enterococci in the gum and heart of dogs with PD. Samples were collected during necropsy of 32 dogs with PD and visually diagnosed with IE, which died of natural causes or euthanasia. Enterococci were isolated, identified and further characterized by Pulsed-Field Gel Electrophoresis (PFGE); susceptibility to antimicrobial agents and pathogenicity potential was also evaluated. In seven sampled animals, PFGE-patterns, resistance and virulence profiles were found to be identical between mouth and heart enterococci obtained from the same dog, allowing the establishment of an association between enterococcal periodontal disease and endocarditis in dogs. These findings represent a crucial step towards understanding the pathogenesis of PD-driven IE, and constitute a major progress in veterinary medicine.
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Project description:BackgroundThe Ross procedure can be an ideal option in infective endocarditis (IE) due to greater resistance to infection. However, limited literature has highlighted the comparison with conventional prostheses in this setting.MethodsBetween February 2013 and September 2022, 25 patients (median age, 50 years) underwent a Ross procedure for IE (Ross group). The results were compared with those after other aortic valve procedures (aortic valve replacement and aortic root replacement) for IE (n = 37, other group.ResultsThe patients in the Ross group included more intravenous drug users and had more prosthetic valve endocarditis and annular abscess formation compared with the other group. Although cardiopulmonary bypass time and aortic cross-clamp time were significantly longer (P < .001 and P = .003, respectively) and the blood requirements were significantly higher (P = .001) in the Ross group, most postoperative short-term outcomes were equivalent between the 2 groups. During follow-up, 1 patient (4%) required reoperation in the Ross group, whereas 6 patients (16%) required reoperation in the other group. Freedom from composite events was significantly better in the Ross group (P = .04). Multivariable analysis found the Ross procedure, compared with other procedures, was a significant independent protective factor for composite end points (P = .03).ConclusionsFor IE, despite surgical complexity, the Ross procedure yielded short-term outcomes similar to other procedures. In the midterm, the Ross procedure provides a lower reoperation rate, resulting in significantly fewer composite events. The Ross procedure appears to be a better option for patients with IE, but long-term follow-up is necessary.
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Project description:Infective endocarditis (IE) is caused by bacterial vegetation in valves, but it can also occur in implanted mechanical devices. We report a rare case of IE occurring at the site of percutaneous atrial septal closure devices in a patient in her 50s that had been placed for residual defects on a closure patch in her childhood for an atrial septal defect (ASD). She also had a medical history of distal pancreatectomy for insulinoma in her 40s and had insulin-dependent diabetes mellitus, which means she had been immunocompromised. She visited our hospital with complaints of fever and lumbar pain. A computed tomography scan revealed liver abscess. In blood, urine, and drainage specimens submitted for culture testing, extended spectrum beta-lactamase-producing Escherichia coli was cultured in all specimens. Echocardiography showed vegetation at the atrial septal closure devices. In accordance with IE therapy, removal of the atrial septal patch and closure device was performed after antibiotic treatment for 6 weeks. Because the atrial septal patch was calcified and the two devices implanted on the patch were not well covered by neointima, bacteria could easily form vegetation. Percutaneous residual ASD closure on an atrial patch, especially for immunocompromised hosts, should be carefully considered. Learning objective In general, neointima forms and coats a closure device several years after its insertion. However, as in the present case, the closed atrial septal patch may be severely calcified and the neointima may not be sufficiently formed on the closure device, and infective endocarditis may occur at the site of implantation. In some cases, the indication for closure device implantation after atrial septal patch closure should be carefully considered.
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