1/239. Comparison of transesophageal to transthoracic color Doppler echocardiography in the identification of intracardiac mycotic aneurysms in infective endocarditis.We report on cases of mycotic aneurysms in a group of 14 patients with infective endocarditis, all of whom were evaluated with transthoracic (TTE) and transesophageal (TEE) color Doppler echocardiography. Four mycotic aneurysms were found, one each in the left ventricular outflow tract, the right coronary sinus of valsalva, the anterior mitral leaflet, and the atrial septum. With TTE, only three of four cases of mycotic aneurysms could be detected. Utilizing TEE, however, all were detected and their connections with the heart chambers or great vessels could be readily and clearly depicted, especially those in the atrial septum and mitral leaflet. We are of the opinion that TEE is superior to TTE in the identification and detailed analysis of mycotic aneurysms complicating infective endocarditis. In addition, we feel that echocardiography may help evaluate the progress of the disease, the location and direction of infection, and the extent of involvement of the mycotic aneurysms, providing useful information for guiding surgical intervention.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
2/239. Video-assisted crossover iliofemoral obturator bypass grafting: a minimally invasive approach to extra-anatomic lower limb revascularization.Graft infection continues to be one of the most feared complications in vascular surgery. It can lead to disruption of anastomoses with life-threatening bleeding, thrombosis of the bypass graft, and systemic septic manifestations. One method to ensure adequate limb perfusion after removal of an infected aortofemoral graft is extra-anatomical bypass grafting. We used a minimally invasive, video-assisted approach to implant a crossover iliofemoral obturator bypass graft in a patient with infection of the left limb of an aortofemoral bifurcated graft. This appears to be the first case report describing the use of this technique.- - - - - - - - - - ranking = 2keywords = infection (Clic here for more details about this article) |
3/239. salmonella mycotic aneurysms: traditional and "alternative" surgical repair with arterial homograft.salmonella infection of the abdominal aorta with formation of mycotic aneurysm is rare, but associated with a high mortality and morbidity. Prompt surgical treatment and selective and prolonged antibiotic therapy are required because of its rapid and impredictable evolution in a short period of time, even if an infectivous etiology is only suspected. methods of revascularization can be different: the traditional two are in situ or extraanatomic bypass using synthetic graft. Both these solutions are subject to complications. An "alternative" method of revascularization with low risk of infection and good patency is the use of arterial homograft in situ. We report two cases of salmonella mycotic aortic aneurysms successfully treated with revascularization respectively by extraanatomic bypass using synthetic graft and in situ arterial homograft. The reasons for our choice are also discussed.- - - - - - - - - - ranking = 2keywords = infection (Clic here for more details about this article) |
4/239. Cryptococcal aortitis presenting as a ruptured mycotic abdominal aortic aneurysm.Mycotic processes occasionally complicate atherosclerotic aortic disease and usually require aggressive surgical therapy to control sepsis and prevent arterial rupture. Rarely, fungal organisms are responsible for primary infection of the abdominal aorta. We report the first case of Cryptococcal aortitis presenting as a ruptured abdominal aortic aneurysm. The surgical, pathologic, and microbiologic aspects of fungal aortitis are discussed.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
5/239. The spectrum of aortic complications after heart transplantation.BACKGROUND: The connection between the donor and the recipient aorta is a potential source of early and late complications as a result of infection, compliance mismatch, and technical and hemodynamic factors. Moreover, the abrupt change in systolic pressure after heart transplantation involves the entire thoracic aorta in the risk of aneurysm formation. The aim of this study was to analyze the types of aortic complications encountered in our heart transplantation series and to discuss etiology, diagnostic approach, and modes of treatment. methods: Of the 442 patients having orthotopic heart transplantation and the 11 patients having heterotopic heart transplantation at our center, 9 (2%) sustained complications involving the thoracic aorta. These 9 patients were divided into four groups according to the aortic disease: acute aortic rupture (2 patients); infective pseudoaneurysm (3 patients); true aneurysm and dissection of native aorta (2 patients); and aortic dissection after heterotopic heart transplantation (2 patients). Surgical intervention was undertaken in 8. RESULTS: Five (83%) of 6 patients who underwent surgical treatment for noninfective complications survived the operation, and 4 are long-term survivors. One patient who underwent a Bentall procedure 71/2 years after heterotopic heart transplantation died in the perioperative period of low-output syndrome secondary to underestimated chronic rejection of the graft. One patient with pseudoaneurysm survives without surgical treatment but died several years later of cardiac arrest due to chronic rejection. Both patients operated on for evolving infective pseudoaneurysm died in the perioperative period. CONCLUSIONS: Infective pseudoaneurysms of the aortic anastomosis are associated with a significant mortality. In noninfective complications, an aggressive surgical approach offers good long-term results. The possibility of retransplantation in spite of complex surgical repair should be considered in the late follow-up after heart transplantation, due to the increasing incidence of chronic rejection.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
6/239. Fungal intracranial aneurysm in a child with familial chronic mucocutaneous candidiasis.We report on a patient who presented at 5 years of age with a hemiparesis due to a middle cerebral artery infarction. An embolism had originated from a mycotic aneurysm located in the internal carotid artery. For several months prior to admission he had been suffering from therapeutically resistant candidiasis of the mouth and nails. family history revealed chronic mycotic infections of the skin, hair, nails and mouth in the father and paternal grandmother suggestive of chronic mucocutaneous candidiasis with autosomal dominant mode of inheritance. Clipping of the aneurysm, after 3 months of anti-mycotic treatment, followed by sustained treatment with itraconazole and fluconazole, led to a favourable outcome. CONCLUSION: Chronic mucocutaneous candidiasis can be associated with an intracranial aneurysm and complicated by cerebral infarction.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
7/239. Mycotic aneurysm of the ascending aorta following CABG.Mycotic aneurysm of the thoracic aorta is a rare and life threatening condition. Two patients are presented (both male, aged 66 and 59 years) in whom coronary artery bypass surgery was complicated by the development of a mycotic aneurysm. fever preceded the radiological and echocardiographic signs of the aneurysm by at least several months in both cases. blood cultures were negative for one patient and the source of corynebacterium sp infection in the other was not determined for several months. Both patients died before surgery could correct the aneurysm.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
8/239. salmonella infection of a ventricular aneurysm with mural thrombus.We describe a case of salmonella infection of a left ventricular aneurysm with a mural thrombus and review 12 cases described in the literature. This entity should be looked for in any patient with persistent or relapsing salmonella bacteremia in whom an intracardiac thrombus is demonstrated. Nuclear imaging may help in the diagnosis. A combined medical and surgical approach should be aggressively pursued because patients who do not undergo an aneurysmectomy are unlikely to survive.- - - - - - - - - - ranking = 5keywords = infection (Clic here for more details about this article) |
9/239. In situ prosthetic graft repair of a mycotic aneurysm of the aorta after orthotopic liver transplantation.BACKGROUND: Vascular complications after liver transplant are associated with a high incidence of graft failure and mortality. Mycotic aneurysms, although uncommon, carry the additional risk of infection and rupture. methods: We report a case of a 51-year-old woman who developed a mycotic aneurysm of the aorta secondary to construction of an infrarenal donor iliac artery graft during a retransplant. We evaluated risk factors for the aneurysm, appropriate diagnosis, and potential treatments. RESULTS: The aneurysm was repaired with an in situ prosthetic graft. The patient is alive with good liver function 31 months posttreatment. CONCLUSIONS: The use of in situ prosthetic grafts for repair of mycotic aneurysms is appropriate in certain situations and may be life-saving.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
10/239. Mycotic pseudoaneurysm of the aorta in children.Mycotic pseudoaneurysm of the aorta is a rare disease in childhood. We report on two cases which were diagnosed in an unselected general pediatric population within an 8-month period. The first case was a 16-month-old toddler with a normal cardiac history who presented with purulent pericarditis due to group A streptococcus and subsequent pseudoaneurysm formation of the ascending aorta while convalescing from varicella infection. The second case was a 14-year-old girl with a previously undiagnosed coarctation of the aorta who developed a staphylococcus aureus aortitis in the dilated poststenotic segment with pseudoaneurysm formation and infiltration into the adjacent lung tissue. In both cases parenteral antibiotic therapy was administered over 10 and 4 days, respectively, followed by emergency surgery consisting of aneurysmectomy, coarctectomy (case 2), and in situ homograft implantation. Recovery was uneventful. In both cases early institution of a femorofemoral cardiopulmonary bypass prevented a fatal outcome despite intraoperative rupture of the pseudoaneurysm.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
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