Cases reported "Streptococcal Infections"

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1/12. Transoesophageal echocardiographic diagnosis of aortico-left atrial fistula in aortic valve endocarditis.

    Intra-cardiac fistulas are rarely seen and they are estimated to account for <1% of all cases of infective endocarditis. Fistulization of paravalvular abscesses has been found in 6% to 9% of cases. This is a report of an unusual communication between the abscess region in the aortic root and the left atrium. A 44-year-old patient diagnosed with infective endocarditis had continuous fevers despite antibiotic therapy. Transoesophageal echocardiography revealed multiple vegetations on aortic valve, fistulization of an aortic root abscess to the left atrium and mitral regurgitation and moderate aortic regurgitation. At surgery, multiple vegetations on the aortic valve and a large abscess cavity establishing direct communication between aortic root and the left atrial cavity through a fistulous tract were discovered. This experience demonstrates the improved sensitivity and specificity of transoesophageal echocardiography in defining periannular extension of infective endocarditis.
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2/12. Mycotic aneurysms of aortic root and aorta-to-left atrial fistula complicating bicuspid aortic valve endocarditis.

    Unlike root abscess, fistula formation is quite uncommon in aortic valve endocarditis. In this report, we describe a patient with subacute bicuspid aortic valve endocarditis complicated by aortic insufficiency, mycotic aneurysms of the aortic root and fistulous communication between the aorta and the left atrium and his recovery upon surgical treatment.
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3/12. Left ventricular outflow tract to left atrial communication secondary to rupture of mitral-aortic intervalvular fibrosa in infective endocarditis: diagnosis by transesophageal echocardiography and color flow imaging.

    infection of the mitral-aortic intervalvular fibrosa occurs most commonly in association with infective endocarditis of the aortic valve. infection of the aortic valve results in a regurgitant jet that presumably strikes this subaortic interannular zone of fibrous tissue and produces a secondary site of infection. infection of this interannular zone then leads to the formation of subaortic abscess or pseudoaneurysm of the left ventricular outflow tract. This infected zone of mitral-aortic intervalvular fibrosa or subaortic aneurysm can subsequently rupture into the left atrium with systolic ejection of blood from the left ventricular outflow tract to the left atrium. This report describes the echocardiographic findings in three patients with pathologically proved left ventricular outflow tract to left atrial communication. Precise preoperative diagnosis is important, and this lesion should be differentiated from ruptured aneurysm of the sinus of valsalva and perforation of the anterior mitral leaflet. Transthoracic echocardiography using color flow imaging and conventional Doppler techniques may show an eccentric mitral regurgitation type of signal in the left atrium originating from the region of the left ventricular outflow tract. However, transesophageal echocardiography provides an accurate preoperative diagnosis and should be used intraoperatively during repair of such lesions.
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4/12. Left ventricular to left atrial communication secondary to a paraaortic abscess: color flow Doppler documentation.

    Aortic root abscess occurs frequently in aortic prosthetic valve infective endocarditis. The present echocardiographic report documents a ruptured abscess that led to a direct communication between the left ventricular outflow tract and the left atrium confirmed by real-time (color flow) Doppler imaging.
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5/12. Right atrial vegetation in left ventricular-right atrial communication.

    We report a case of right-sided endocarditis with left ventricular-right atrial communication in which right atrial vegetation was demonstrated by two-dimensional echocardiography. The present case demonstrates that the right atrial vegetation in ventricular septal defect is suggestive of left ventricular-right atrial communication.
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6/12. Carcinoma of the colon presenting as streptococcus sanguis bacteremia.

    bacteremia by streptococci that normally inhabit the gastrointestinal tract has been associated with colon carcinoma. Such association is best known for streptococcus bovis, but has also been reported for other streptococci. In the present communication a patient is described who presented with streptococcus sanguis bacteremia and was subsequently found to suffer from an adenocarcinoma of the sigmoid. A possible association between bacteremia by commensal streptococci of both the upper and lower gastrointestinal tract and colon carcinoma is discussed.
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7/12. Echocardiographic identification of infective endocarditis within a congenital left sinus of valsalva-right atrial communication.

    A rare case is described of infective endocarditis within a congenital left sinus of valsalva aneurysm to right atrial communication diagnosed by a combination of precordial and transesophageal echocardiography. The respective roles of precordial and transesophageal echocardiography in this case are discussed with regard to both diagnosis and surgical decision making.
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8/12. The successful surgical repair of a left ventricular-right atrial communication and aneurysm of the mitral valve caused by infective endocarditis: report of a case.

    We report herein the case of a 42-year-old man who developed a left ventricular-right atrial communication and aneurysm of the mitral valve caused by infective endocarditis, which was associated with aortic regurgitation. Based on the findings of congestive heart failure, prolongation of the PR interval, and the added threat of rupture of the mitral aneurysm, surgical treatment was decided upon as the best course of action. The aortic and mitral valves were replaced with prosthetic mechanical valves, and the septal communication was simultaneously closed with a patch. The patient's postoperative course was uneventful and he has been in good health since. Thus, we believe that aggressive surgical intervention for complicated lesions such as those seen in our patient may be life-saving, even in the presence of inflammatory signs.
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9/12. orbital cellulitis--an unusual presentation and late complication of severe facial trauma.

    We report an unusual case of orbital cellulitis in a patient with only one seeing eye and severe facial asymmetry secondary to a road traffic accident twenty two years previously. Facial trauma sustained in the road traffic accident created continuity between the right orbit and the adjacent ethmoidal cells. The abnormal communication between the ethmoidal labyrinth and the right orbit rendered this patient highly susceptible to an orbital cellulitis from an adjacent paranasal sinus infection. However, this case is unusual with regard to the length of time that elapsed before such an infection became manifest and the presence of gross distortion of anatomy masked the usual presentation and thereby caused a delay in diagnosis.
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10/12. mitral valve prosthetic endocarditis: development of left ventricular-coronary sinus fistula following replacement.

    We report the history and course of a patient in whom a left ventricular-coronary sinus fistula developed following mitral valve replacement due to prosthetic endocarditis. Six months after the intervention the patient suddenly presented with deterioration of her symptoms, holosystolic murmur and signs of congestive heart failure. Transesophageal echocardiography showed a left-to-right shunt but did not show its exact location. At surgery, exploration of the right atrium revealed a left ventricular-coronary sinus communication due to discontinuation of the left ventricular free wall next to the coronary sinus; repair of the defect was successfully performed by direct suture. The postoperative course was uneventful and the patient recovered quickly. This case is reported to stress that debridement of the mitral annulus and removal of an old prosthesis must be very carefully performed and to facilitate the diagnosis of this rare but severe complication of repeated mitral valve replacement.
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