1/10. 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 = vessel (Clic here for more details about this article) |
2/10. Mycotic aneurysms affecting both lower legs of a patient with candida endocarditis--endovascular therapy and open vascular surgery.The purpose of this study was to report the endovascular and open surgery treatment of candida-associated mycotic aneurysms in both lower limbs. A 53-year-old patient suffering from candida endocarditis following aortic valve replacement developed mycotic aneurysms in both lower limbs. The angiography revealed a large aneurysm of the tibioperoneal trunk affecting the right leg. In the left leg, sacculation had developed in section III of the popliteal artery. The right aneurysm was obliterated by embolization with coils. On the left side, the large aneurysm of the popliteal artery was resected; vascular continuity was re-established by interposing a segment of the patient's greater saphenous vein. The postoperative course was uneventful. Mycotic aneurysm is a rare disease. A site in the crural vessels is regarded as exceptionally seldom. To our knowledge, no candida-associated mycotic aneurysm has been described in this region before. Both endovascular treatment and open surgery proved to be successful.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/10. Operative intervention in active endocarditis in children: report of a series of cases and review.We describe in detail 14 children (age, less than or equal to 19 years) who underwent operative intervention during active infection of the heart and/or great vessels. The series included five children less than 6 years old, who constitute 10% of all such cases reported in this age group to date. We also review the 132 published reports in which children underwent operative intervention during active endocarditis. We found the following: (1) The survival rate for all cases was 77%. (2) Persistent infection, embolic phenomena, and increasing congestive heart failure were the most frequent indications for operative intervention. (3) Survival rates were independent of the duration of preoperative antibiotic treatment. (4) Survival rates were independent of positive results of cultures of blood or tissue obtained at operation. (5) The perioperative mortality in our series was 14%. (6) Only 67% of patients had conditions thought to predispose to endocarditis. (7) Except for removal of catheter-associated cardiac masses from neonates, operative intervention in active endocarditis was uncommon among children less than 4 years old. (8) staphylococcus aureus and viridans streptococci were the etiologic agents in the majority of cases of endocarditis requiring operation during active infection in children.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/10. endocarditis and ulnar artery aneurysm as presenting features of antiphospholipid syndrome and polyarteritis nodosa.antiphospholipid syndrome in association with vasculitis is highlighted in this report. The combination of thrombotic and inflammatory processes resulted in endocarditis, aneurysm formation and thrombosis. To our knowledge this is the first presentation of a large vessel aneurysm in these conditions. Anticoagulation and immunosuppression are the treatment modalities of choice.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/10. Aspergillus endocarditis in association with a false aortic aneurysm.A 32-year-old man was admitted with an intracerebral hematoma and subsequently with bilateral femoral emboli five months after aortic valve replacement. Blood cultures for bacteria and fungi were negative but microscopy of the embolus revealed aspergillus fumigatus. At operation a large false aneurysm of the ascending aorta and vegetations on the prosthetic aortic valve were found. Aspergillus endocarditis is diagnosed antemortem in only 23% of fatal aortic aneurysms: blood cultures are positive in only 8%. Clinically a large vessel embolus is characteristic, being present in 83% and microscopy and culture of such an embolus if present are vital investigations.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/10. Multiple mycotic aneurysms due to candida endocarditis.candida endocarditis is a serious condition which should be suspected in any patient with signs and symptoms compatible with bacterial endocarditis when cultures are negative. It should be managed by a medical-surgical approach which combines resection of all infected heart tissue and repair of any preexisting heart defects with appropriate antifungal therapy. Mycotic aneurysms should be treated by ligation of the vessel above and below the aneurysm, resection of the aneurysm, and implementation of appropriate antifungal or antibacterial therapy. Revascularization is not always necessary. When required, an extra-anatomic approach is preferable to placing a graft through the bed of the aneurysm.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/10. Mycotic emboli of the peripheral vessels: analysis of forty-four cases.Two cases of mycotic emboli of the peripheral vessels are presented, and 42 additional cases from the literature are analyzed. male patients predominate 3:1. candida and Aspergillus are the usual pathogens. Initial presentation as large vessel peripheral emboli is characteristic (77%), with emboli originating from either the aortic or mitral valves. Cerebral emboli may proceed of follow the peripheral embolization. Predisposing factors include open-heart surgery, antibiotic therapy, concomitant infection, and intravenous drug abuse. Early symptoms of fungemia are nonspecific, with blood cultures positive in only 43% of cases. The overall mortality rate was 84%-73% in patients who did not undergo previous open-heart surgery, and 96% in patients who underwent previous open-heart surgery. patients with candida infection seem to do better than those with Aspergillus endocarditis (19% survival versus 5%). Aggressive therapy, including embolectomy, early valve replacement, and prolonged antifungal drug therapy, is advised.- - - - - - - - - - ranking = 6keywords = vessel (Clic here for more details about this article) |
8/10. Left ventricular outflow tract pulmonary artery fistula in endocarditis.patients with infective endocarditis are at risk for the development of a fistulous communication between chambers or great vessels of the heart. The presence of a continuous murmur may suggest the diagnosis. The first case of aortic valve endocarditis complicated by the development of a fistulous communication between the left ventricular outflow tract and the pulmonary artery is reported. Transesophageal Doppler echocardiography did not detect the defect preoperatively. However, pulmonary artery catheterization revealed very high mixed venous oxygen saturation which supported the presence of a left-to-right shunt.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/10. Postpump retinopathy.Postpump syndrome is a systemic manifestation which occurs somewhat frequently after cardiac surgery when cardiopulmonary bypass (CPB) is used. It is probably caused by platelet injury secondary to plasma contact with the CPB machinery. Damaged platelets aggregate and result in small emboli which course throughout the body, causing short-lived infarcts in the smaller blood vessels in multiple organs including the eyes where the result is retinopathy. Postpump syndrome is well documented in the cardiovascular literature but not in the ophthalmologic literature. We report a case of postpump syndrome retinopathy seen in a 56-year-old black male who had previously undergone valve replacement surgery for endocarditis. Follow-up revealed a postoperative embolus which necessitated further evaluation by the cardiologist and cooperative care with the optometrist/ophthalmologist team at The eye Institute. Sequential photographs document this retinopathy as well as the embolic complication.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/10. Non-toxigenic corynebacterium diphtheriae: two cases and review of the literature.Non-toxigenic corynebacterium diphtheriae infections are being reported with increasing frequency. We present two cases of C. diphtheriae endocarditis requiring early valve replacement. Both cases were complicated by cerebral embolic phenomena and pseudoaneurysm formation in lower limb arterial vessels. Non-toxigenic C. diphtheriae septicaemia must be excluded when 'diphtheroids' are isolated from blood cultures.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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