1/100. Echocardiographic detection of bacterial vegetations in a child with a ventricular septal defect.A 13-year-old boy with a small ventricular septal defect was admitted with clinical manifestations of acute endocarditis. coagulase-positive staphylococci were isolated from the blood. Definitive diagnosis was made by detecting bacterial vegetations in the right ventricle on the echocardiogram. Repeated embolization of these vegetations to the pulmonary circulation led to the death of the patient.- - - - - - - - - - ranking = 1keywords = circulation (Clic here for more details about this article) |
2/100. Echocardiographic features of an unusual case of aortic valve endocarditis.In a patient with aortic valve endocarditis a myocardial abscess, complete heart block and acute aortic regurgitation developed. echocardiography gave evidence of large aortic valve vegetations, and at operation vegetations were found to have destroyed the right coronary cusp and part of the noncoronary cusp. Following surgery the patient recovered. echocardiography may prove to be a useful noninvasive technique to aid in the timing of surgical therapy in patients with valvular vegetations.- - - - - - - - - - ranking = 52.080017301038keywords = coronary (Clic here for more details about this article) |
3/100. aortic valve replacement after retrosternal gastric tube reconstruction for esophageal cancer.A 59-year-old man with a history of the thoraco-abdominal esophagus resection with retrosternal gastric tube reconstruction for esophageal cancer complicated by anastomosis leakage and purulent pericarditis was admitted for aortic regurgitation due to infective endocarditis. Floppy vegetation and worsening cardiac failure indicated aortic valve replacement. In a median sternotomy approach, the thickest adhesion between the cervical esophagus and posterior surface of the manubrium sternae was freed using an ultrasonic osteotome. Severe adhesions in the pericardium due to purulent pericarditis were found. Median sternotomy enabled minimal exposure of the aortic root, upper right atrium, and right superior pulmonary vein for instituting extracorporeal circulation and replacing the aortic valve. The patient's postoperative course was uneventful. For cardiac surgery in patients with a retrosternal gastric tube, left anterior or right thoracotomy may be considered to avoid gastric tube injury. Median sternotomy, however, is an alternative enabling safe heart exposure, and the ultrasonic osteotome was very useful in incising the sternum without injuring the cervical esophagus, which had no serosa.- - - - - - - - - - ranking = 1keywords = circulation (Clic here for more details about this article) |
4/100. myxoma of mitral valve associated with infective endocarditis.A 20-year-old man was hospitalized for persistent fever, embolism, and syncopal attack. echocardiography demonstrated a tumor on the mitral posterior leaflet. It was removed under extracorporeal circulation following extirpation of thrombus in the right common like artery. The tumor consisted of myxoma and vegetation with bacterial colony. myxoma and/or vegetation had destroyed the mitral posterior leaflet. Accordingly, it was necessary to perform mitral valve replacement. The postoperative course was uneventful. This is the 14th surgical case of mitral valve myxoma, and the first case of that associated with infective endocarditis.- - - - - - - - - - ranking = 1keywords = circulation (Clic here for more details about this article) |
5/100. Inverse paradoxical embolism in a patient on chronic hemodialysis with aortic bacterial endocarditis.We present a 45-year-old patient on chronic hemodialysis who suffered aortic endocarditis by staphylococcus haemolyticus after bacteremia associated with a venous catheter, which was used temporarily during the maturing phase of a Cimino-Brescia arteriovenous fistula in the left forearm. Three weeks after starting antibiotic therapy, the patient suffered a septic pulmonary embolism. The catheter had been removed 4 weeks before the embolism. thrombophlebitis of lower limbs, infection or thrombosis of the vascular access, and the involvement of right-sided cardiac structures were all discarded. We assumed that the pulmonary episode was probably a consequence of the paradoxical passage of embolic material, detached from the aortic valve, from arterial to venous circulation through the arteriovenous fistula.- - - - - - - - - - ranking = 1keywords = circulation (Clic here for more details about this article) |
6/100. Community-acquired methicillin-resistant staphylococcus aureus endocarditis with septic embolism of popliteal artery: a case report.A 20-year-old man presented with a 14-day course of fever. physical examination showed petechiae of the conjunctivae, Janeway lesions on both hands, a grade III/VI systolic murmur over the apex, pulseless dorsal pedal artery and posterior tibial artery of the right leg, and a pale right foot. Femoral arteriogram of the right leg revealed total occlusion of the popliteal artery with collateral circulation of the posterior tibial artery. Transthoracic echocardiogram showed trace mitral regurgitation. embolectomy of the right popliteal artery was done, and penicillin and gentamicin treatment was administered. However, postoperative fever developed intermittently. Transesophageal echocardiogram disclosed vegetation over the anterior leaflet of the mitral valve. methicillin-resistant staphylococcus aureus (MRSA) was isolated from all three cultures of blood drawn at admission and from the septic embolus during operation. He had neither evidence of underlying heart disease, nor history of intravenous drug abuse or hospitalization. Exploratory cardiotomy with removal of vegetation on the mitral valve was performed followed by a 4-week treatment with intravenous vancomycin. After discharge, he was well at 2-year follow-up.- - - - - - - - - - ranking = 1keywords = circulation (Clic here for more details about this article) |
7/100. Fatal left main coronary artery embolism from aortic valve endocarditis following cardiac catheterization.Coronary artery embolization has been associated with sudden cardiac death. It is more commonly seen with aortic valve endocarditis. It manifests as acute myocardial ischemia or infarction, causing instability of the cardiac rhythm, which may be fatal. We report a patient with aortic valve endocarditis who had sudden cardiac death following coronary angiography. autopsy revealed embolic occlusion of the left main coronary artery.- - - - - - - - - - ranking = 156.24005190311keywords = coronary (Clic here for more details about this article) |
8/100. Infective endocarditis affecting both systemic and pulmonary circulations predisposed by a ventricular septal defect.A 39-year-old woman was admitted to our hospital presenting persisting fever. An echocardiographic examination showed severe aortic and mitral valve regurgitation with moderate tricuspid regurgitation. Small left-to-right shunt through the ventricular septal defect was identified. Vegetation was also detected on the tricuspid, mitral, and aortic valves. At one month after admission, the patient showed sudden onset of headache and abdominal pain. A computed tomographic scan demonstrated cerebral and splenic infarction. A pulmonary perfusion scintigram demonstrated perfusion defects in left-S1 and right-S6 regions. At 4 months after admission, as operation was performed. The aortic valve was replaced with a #23 mm CarboMedics prosthesis and the mitral valve with a #29 mm Carbo Medics prosthesis. tricuspid valve plasty was performed, with closure of He laceration and perforation of the anterior leaflet combined with a commissuroplasty, according to Kay's method. Ventricular septal defect was closed with a bovine pericardial patch. She was discharged at 19 days after the operation, and is leading a good life. Pervasion of the organism seemed to be initiated from the mitral valve which was conveyed by the blood stream to the aortic valve, and to the tricuspid valve through the ventricula septal defect. Left heart evaluation may be important in cases with infective endocarditis and ventricula septal defect.- - - - - - - - - - ranking = 4keywords = circulation (Clic here for more details about this article) |
9/100. staphylococcal scalded skin syndrome with prosthetic valve endocarditis.We report staphylococcal scalded skin syndrome (SSSS) in a 67-year-old man. He showed diffuse erythema with erosion on his face and erythema with giant desquamation on his neck, axilla, genitalia, chest and abdomen 39 days after a coronary artery bypass graft and aortic valve replacement. He died of cardiac rupture caused by myocardial necrosis, and autopsy findings demonstrated prosthetic valve endocarditis due to a strain of exfoliative toxin-B producing methicillin-resistant staphylococcus aureus. To the best of our knowledge, this is the first case of SSSS caused by prosthetic valve endocarditis.- - - - - - - - - - ranking = 26.040008650519keywords = coronary (Clic here for more details about this article) |
10/100. Pseudoaneurysm complicating homograft aortic valve replacement--two different--courses and strategies.The courses of two patients with pseudoaneurysm formation following aortic valve replacement using homografts are reported. Both patients had aortic valve replacement due to acute infective endocarditis with paravalvular abscess formation. The first case had an uneventful postoperative course; but on routine echocardiography, a pseudoaneurysm located at the left coronary commissure was found at one year follow-up. As the pseudoaneurysm was completely asymptomatic, the patient was followed up carefully at six months intervals. The second patient also had pseudoaneurysm formation postoperatively, but he presented one year after surgery with fever and elevated leucocyte count. He had surgical revision of the pseudoaneurysm because no other reason for an infection could be found. Four months later he presented again with infection signs and pseudoaneurysm formation. This time, the homograft was completely excised and another homograft was implanted. One year after the final operation, he is now free from re-infection. The two presented courses show that pseudoaneurysms complicating aortic valve replacement should be managed according to attendant circumstances and symptoms.- - - - - - - - - - ranking = 26.040008650519keywords = coronary (Clic here for more details about this article) |
| | Next -> |