Endocardial Abscesses in Children: Case Report and Review of the Literature (original) (raw)
Related papers
Endocarditis-Associated Paravalvular Abscesses
CHEST Journal, 1995
Study objective: To determine whether standard clinical and transthoracic echocardiographic criteria considered to be suggestive of the presence of endocarditisassociated paravalvular abscess are predictive of which patients would benefit from reliable but invasive transesophageal echocardiographic investigations for abscess. Design: Retrospective chart review. Setting: A 630-bed university hospital. Patients: Forty-eight patients with 51 episodes of definite endocarditis and 24 paravalvular abscesses. Measurements and results: A comparison of abscess and nonabscess populations revealed that clinical parameters (patient demographics, valvular involvement, presence of a prosthesis, infection with a virulent organism, pericarditis, persistent fever, persistent bacteremia, congestive heart failure, history of intravenous drug use, embolization) and transthoracic echocardiographic parameters were insensitive predictors of the paravalvular abscess is a serious complication of infective endocarditis, occurring in 23% of patients with left-sided disease who undergo valve replacement, 40% of patients with native aortic valve involvement, and 56 to 100% of patients with prosthetic valve endocarditis.1'8 Abscesses can reflect extensive valvular dysfunction and are associated with increased morbidity and mortality."3'5'7'9 The presence of a paravalvular abscess is a relative indication for surgery, and standard surgical procedures frequently must be adapted to address adequately the
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
Root abscess in the setting of infectious endocarditis: Short- and long-term outcomes
The Journal of Thoracic and Cardiovascular Surgery, 2020
Objectives: To evaluate the impact of an aortic root abscess on perioperative outcomes and long-term survival in patients with active infectious endocarditis treated surgically. Methods: From 1996-2017, 336 consecutive patients were treated with aortic valve or root replacement for active endocarditis, including patients with (n=179) or without (n=157) a root abscess. Data was obtained from the Society of Thoracic Surgery data warehouse, through chart review, patient surveys, and the National Death Index data. Results: Demographics were similar between groups except the root abscess group had a significantly lower prevalence of congestive heart failure (CHF) and higher rates of prosthetic valve endocarditis. The abscess group had significantly more aortic root replacements, longer cardiopulmonary bypass and cross clamp times. Operative mortality was 8.4% and 3.8% (P=.11) for the abscess and no abscess groups, respectively. Nevertheless, the root-abscess group had prolonged ventilation and longer ICU stays. Kaplan-Meier survival was similar between root abscess and no abscess groups (10-year survival 41% vs. 43%, P=.35). Significant risk factors for all-time mortality included all categories of age (hazard ratio, HR= 1.64-2.85), the presence of a root abscess (HR=1.42), IV drug use (HR=1.81), CHF (HR= 1.72), renal failure requiring dialysis (HR=3.26), and liver disease (HR=3.04). The 10-year rate of reoperation was also similar between groups (5.9% vs. 7.9%). Conclusions: Thorough and extensive debridement is critical for successful treatment of active endocarditis with root abscess. Bioprosthetic stented and stentless valves are valid conduits to treat endocarditis with root abscess.
Cureus, 2022
A 38-year-old female with no known comorbidities or previous history of heart disease presented to the hospital with a three-day history of drowsiness and shortness of breath. Transthoracic echocardiography was performed, which showed large vegetations on aortic and tricuspid valves. In addition, there was severe aortic regurgitation with a possible abscess on the non-coronary cusp of the aortic valve. The patient was admitted, and a provisional diagnosis of disseminated tuberculosis, Infective endocarditis (IE), and sepsis was made. Surgical intervention was planned. Intraoperative findings revealed that a fistula had formed connecting the aorta and right atrium, which was closed with an autologous graft derived from the patient's pericardial tissue. Vegetations were removed, and the aortic valve was replaced with a metallic valve. This case report presents a patient with complicated IE with a ruptured aortic root abscess. Mechanical complications associated with IE, such as in our case, are rare among patients with IE. However, surgical intervention should be considered as an option in complicated cases of IE when standard therapy fails.
Interventional Cardiology Journal, 2017
Objectives: To examine the surgical treatment and mortality rate of valvular infective endocarditis complicated by an abscess in patients at a major tertiary care center. Background: Infective endocarditis (IE) involving a heart valve is fatal if left untreated. The appearance of a comorbid abscess impacts the choice of treatment and surgical technique and, in some instances, may present unique technical challenges. Methods: Departmental data from all patients who underwent surgery for IE at a single major tertiary care center from July 2007 to January 2016 were retrospectively screened for the presence of an intracardiac abscess. Patients with at least one confirmed abscess were examined further with respect to the surgical procedures completed and 30-day mortality rate. Results: Over the almost nine years of data collection, we identified 14 patients (9 males, 5 females) with at least one confirmed cardiac abscess. Patients ranged in age from 28 to 77 years old (mean 57.8 ± 14 years). Various surgical procedures were performed, including aortic or/and mitral valve replacement, mitral or/and tricuspid valve repair, and a freestyle prosthetic valve implant in the pulmonary position. In two patients, surgery was extended to include the ascending aorta; while two patients underwent coronary artery bypass grafting. A patch technique was adopted whenever necessary. Overall, 12 patients survived, while one died from septic shock and another from pneumonia. Conclusions: An abscess is a serious complication of valvular infective endocarditis that can appreciably increase the complexity of surgical intervention. In our experience, however, this seemed not to directly affect the 30-day mortality-rate, with both deaths ascribed to disseminated infection.
Aortic Root Abscess in a child: A case report
2014
Although tuberculous aortitis is fairly common in adults, tuberculous mycotic aneurysm of aorta is rare with involvement of aortic root being very uncommon. The diagnosis depends on a combination of clinical criteria, including persistent fever and bacteraemia and echocardiographic confirmation. Because of the rarity of aortic root abscess in children, there is no consensus on a treatment strategy. We describe a 10-year-old male who presented with fever, abdominal pain and headache, and was found to have disseminated tuberculosis and aortic root abscess with mycotic aneurysm. Due to the presence of evidence of tuberculosis elsewhere in the body (multiple tuberculomas in brain, granulomas in liver, lichen scrofulosorum over abdomen), therapy with antituberculous drugs was started to which the patient responded partially, but later died suddenly at home.
Paediatrica Indonesiana
We report clinical and laboratory findings of 15 children with bacterial endocarditis, admitted to the Department of Child Health, University of Indonesia/Cipto Mangunkusumo Hospital from February, 1987 to June, 1989. There were 8 boys and 7 girls with bacterial endocarditis, ranging in age from 10 weeks to 16 years. The diagnosis was suspected because of prolonged fever, with or without other manifestations, i.e. congestive heart failure, refractory anemia, or paroxysmal atrial tachycardia. The underlying heart disease was congenital in 12 cases and rheumatic heart disease in 3 cases. The clinical, electrocardiographic, and radiologic manifestations were generally predominated by the pre-existing heart disease. No 'characteristic' findings of bacterial endocarditis, i.e. Osler's nodes, Janeway lesions or splinter haemorrhages were detected. Positive bacterial culture was obtained in 12 cases; the most frequent bacteria isolated was Pseudomonas aeruginosa (4 cases). Stre...
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.