Disastrous Course of Recurrent Infective Endocarditis after Tooth Extraction in a Young Patient with Bicuspid Aortic Valve (original) (raw)
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Bicuspid Aortic Valve--A Silent Danger: Analysis of 50 Cases of Infective Endocarditis
Clinical Infectious Diseases, 2000
We analyzed 50 cases of bicuspid aortic valve endocarditis in patients who presented to St. Thomas' Hospital from 1970 through 1998. These represented 12.3% of the 408 cases of native valve endocarditis (NVE). All patients were male, and their mean age was 39 years. Fortyfive of the 50 cases were pathologically proven; 47 were clinically definite according to the Duke criteria and 49 according to our modifications of the Duke criteria. Viridans streptococci and staphylococci accounted for 72% of cases. The prevalences of clinical features were similar to those seen in NVE: fever (temperature у38ЊC, 74%) and malaise (70%), although dyspnea was more frequent (36%). There was a high incidence of serious complications (72% heart failure; 30% periannular abscesses). Surgery was required during the initial admission in 82% of cases. Overall mortality was 14%, and surgical mortality was 9%. Few patients knew they had a "heart condition," and a bicuspid aortic valve was detected in only 35% of echocardiograms performed before surgery. A bicuspid aortic valve is the most common congenital heart lesion; according to autopsy studies [1-4], it is found in 1%-2% of the general population. The bicuspid aortic valve was first described as a pathological curiosity in 1844 by Paget; in 1866, Peacock recognized its liability to calcific stenosis; and in 1886, William Osler first associated it with infective endocarditis [5]. The natural history of this valve is of calcification, which occurs in nearly all individuals aged 140 years and is the most common cause of isolated aortic stenosis [1-3, 6-8]. Infective endocarditis (IE) is a well-recognized complication; autopsy evidence suggests that it occurs in 7%-25% of cases and usually presents in the fourth and fifth decades of life. A bicuspid aortic valve may retain normal function (15% to 150% of cases); less often, it results in isolated aortic regurgitation [1-3, 5-7]. In 1923, Lewis and Grant noted that more than one-third of pathological specimens of aortic valves afflicted with IE were bicuspid, and this association has been noted in recently reported series of endocarditis [9-15]. We present 50 cases of IE affecting bicuspid aortic valves and discuss the clinical and microbiological features, pathological diagnosis, and outcome of these cases. Methods We analyzed cases of IE affecting bicuspid aortic valves in patients presenting to St.
Infective endocarditis with a bicuspid aortic valve and ventricle septal defect as a complication
Cardiologia Croatica, 2017
Introduction: Approximately three-fourths of patients with infective endocarditis have a preexisting structural cardiac abnormality at the time of the endocarditis development. Congenital heart lesions predisposing to infective endocarditis include aortic stenosis, bicuspid aortic valve, pulmonary stenosis, ventricular septal defect, patent ductus arteriosus, coarctation of the aorta, and tetralogy of Fallot. Complications of the infective endocarditis include cardiac, neurologic, renal, and musculoskeletal complications, as well as complications related to systemic infection. Cardiac complications are most common and they include: heart failure, perivalvular abscess, pericarditis, intracardiac fistula with myocardial perforation or aortic dissection. Management of patients with infective endocarditis includes antibiotic therapy as well as surgical treatment whenever it is indicated. 1-3 Case report: We present a case report of a case report of a 29-year-old patient with congenital bicuspid aortic valve. Prior to the development of endocarditis the patient underwent a dental procedure without antibiotic prophylaxis. After couple of days he was hospitalized due to clinically signs of sepsis and infective endocarditis was reveled on echocardiography. Patient was treated with antibiotics but due to uncontrolled sepsis and severe aortic stenosis in a bicuspid aortic valve, signs of heart failure developed and patient underwent urgent cardiac surgery where the reconstruction of aortic annulus with bovine pericardium and mechanical aortic valve replacement was done. After surgery despite appropriate antibiotic therapy patient had continuous fever and clinical and laboratory signs of sepsis, so we suspected that abscess was formed. Due to that we performed 3D transesophageal echocardiography which revealed infective endocarditis vegetations on mechanical aortic valve, (Figure 1) paravalvular abscess, ventricular septal defect with significant left to right shunt and instability of mechanical valve, by itself, due to big abscess hole. (Figure 2, Figure 3). After that second cardiac surgery was performed where replacement of mechanical aortic valve with homograft was done, together with surgical repair of ventricular septal defect. After surgery transesophageal echocardiography showed normal function of replaced aortic valve, with mild regurgitation, no signs of infective endocarditis vegetations and without ventricular septal defect. Conclusion: Perivalvular abscess should be suspected in the setting of fever despite appropriate antimicrobial therapy. Transesophageal echocardiography is more sensitive for detection of myocardial abscess than transthoracic echocardiography.
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital, 2009
We retrospectively investigated the impact of bicuspid aortic valve on the prognosis of patients who had definite infective endocarditis of the native aortic valve.Of 51 patients, a bicuspid aortic valve was present in 22 (43%); the other 29 had tricuspid aortic valves. On average, the patients who had bicuspid valves were younger than those who had tricuspid valves. Patients with a tricuspid valve had larger left atrial diameters and were more likely to have severe mitral regurgitation.Periannular complications, which we detected in 19 patients (37%), were much more common in the patients who had a bicuspid valve (64% vs 17%, P = 0.001). The presence of a bicuspid valve was the only significant independent predictor of periannular complications. The in-hospital mortality rate in the bicuspid group was lower than that in the tricuspid group; however, this figure did not reach statistical significance (9% vs 24%, P = 0.15). In multivariate analysis, left atrial diameter was the only ...
An update on infective endocarditis of dental origin
Journal of Dentistry, 2002
The aim of this study was to analyse the prevalence of dental treatment and oral infections related to the development of infective endocarditis (IE). A retrospective study of 103 cases of IE diagnosed from 1997 to 1999 was conducted in Galicia, Spain. According to the Duke's endocarditis criteria (1994), 87 cases (84.5%) were considered definite IE. A presumed oral portal of entry was recorded in 12 patients (13.7%). Oral infections were held responsible in six cases while the remaining six had received dental treatment in the previous three months (three tooth extractions, one scaling, one cleaning, one fillings). In eight cases of IE (66.6%) typical oral pathogenic microflora was identified, with Streptococcus viridans being the most frequent. In four patients no previous cardiac disease was recorded. These results suggest that prevalence and characteristics of IE cases of dental origin did not change significantly in the last decades. The need for increased oral hygiene and improved dental care should be emphasized on preventing IE of dental origin. Continued education of physicians and dentists on the importance of the knowledge of current prophylactic protocols should also be considered.
Journal (Canadian Dental Association), 2008
Infective endocarditis is a rare but life-threatening microbial infection of the heart valves or endocardium, most often related to congenital or acquired cardiac defects. The American Heart Association (AHA) recently updated its recommendations on prophylaxis during dental procedures. The revisions will have a profound impact on both the patient and the dental practitioner. The purpose of this paper is to review the pathogenesis and clinical presentation of infective endocarditis and discuss the 2007 AHA guidelines and their implications for dentists.
Cardiovascular Pathology, 2007
A 46-year-old man presenting with fever, peripheral edema, and chest pain was admitted to the emergency department. Electrocardiogram showed sinus tachycardia and first-degree atrioventricular block. Transesophageal echocardiogram showed infective endocarditis in bicuspid aortic valve, complicated with severe aortic regurgitation, ring abscess, and sinus-of-Valsalva aneurysm extending to mitroaortic fibrous continuity. The patient, who was unaware of his bicuspid aortic valve condition, reported having undergone an orthodontic procedure complicated with dental abscess 1 month prior, which was treated with combined clavulanate-amoxicillin antibiotic therapy. Blood cultures were positive for Bacteroides fragilis resistant to metronidazole. Intravenous antibiotic therapy was undertaken, with rapid resolution of fever. He eventually underwent successful aortic homograft implantation and mitral valve repair with residual first-degree atrioventricular block. D
Azerbaijan Journal of Cardiovascular Surgery, 2022
Abstract Infective endocarditis (IE) is an infection of the inner lining of the heart muscle(endocardium) caused by bacteria, fungi, or germs that enter through the bloodstream. Despite improvements in its management, IE remains associated with high mortality and severe complications. The management of IE is multidisciplinary and is comprised of cardiologists, intensive care physicians, and cardiac surgeons. IE involving coronary ostium is very rare and sometimes such cases can cause acute coronary syndrome or sudden cardiac death. In this article, we report the case of a 48-year-old man who developed infective endocarditis involving aortal and mitral valves, as well as interventricular septum and left main coronary ostium as a result of Enterococcus faecalis. The vegetation on the ostium of the left main coronary artery has not caused coronary obstruction, but because of possible embolic events, all vegetation has been cleaned and a more appropriate repairment technique has been applied. Patient treated with vancomycin, rifampicin, and gentamicin before surgical replacement of damaged valves. We have performed aortic valve replacement, and mitral and tricuspidal valve repairment procedures. Beside of that vegetations on the interventricular septum and on the coronary ostium were extracted and damage repaired. The patient has discharged from the hospital on day 5 postoperatively without any signs of IE. Conclusion E. faecalis-associated infective endocarditis should be included in the differential diagnosis of valvular vegetation, especially in patients with a rapidly progressing clinical course. A multidisciplinary approach to IE is critical for improving the life quality of patients by reducing mortality and preventing complications. This case also highlights the importance of collecting blood cultures before initiation of antibiotic treatment.