Document Detail

A surgical case of prosthetic valve endocarditis with a difficult diagnosis.
MedLine Citation:
PMID:  21881349     Owner:  NLM     Status:  MEDLINE    
Early diagnosis and treatment of prosthetic valve endocarditis (PVE) is important because it has a high mortality rate. We report a case of PVE which was difficult to diagnose. A 36-year-old man, who had undergone an aortic valve replacement (AVR) 7 years prior, was hospitalized with a high fever of unknown origin. We could not detect a stuck valve, vegetations or abscesses using echocardiography, and the peak aortic transvalvular pressure gradient had increased to 81 mmHg. We suspected PVE and initiated intravenous antibiotic therapy immediately. On day 5, echocardiography demonstrated an abnormal shadow directly under the prosthesis, and we definitively diagnosed PVE and performed an operation. Intraoperatively, the prosthesis was not vegetative, but the left ventricular outflow tract was filled with vegetation that was nearly obstructing it. After dissecting the infectious focus, we performed a re-AVR. Postoperative echocardiography showed that the peak left ventricular aortic pressure gradient decreased to 30 mmHg. Obstructive vegetation is difficult to diagnose by preoperative echocardiography.
Hiroki Mizoguchi; Masayuki Sakaki; Kazushige Inoue; Yoshiteru Yoshioka; Yasuyuki Bito
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2011-08-17
Journal Detail:
Title:  Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia     Volume:  17     ISSN:  2186-1005     ISO Abbreviation:  Ann Thorac Cardiovasc Surg     Publication Date:  2011  
Date Detail:
Created Date:  2011-12-22     Completed Date:  2012-04-25     Revised Date:  2012-06-18    
Medline Journal Info:
Nlm Unique ID:  9703158     Medline TA:  Ann Thorac Cardiovasc Surg     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  628-30     Citation Subset:  IM    
Kansai Rousai Hospital, Department of Cardiovascular Surgery, 3-1-69 Inabasou,Amagasaki, Hyogo, Japan.
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MeSH Terms
Anti-Bacterial Agents / therapeutic use
Aortic Valve / surgery*
Device Removal
Endocarditis / diagnosis*,  etiology,  surgery,  ultrasonography
Fever of Unknown Origin / etiology
Heart Valve Prosthesis / adverse effects*
Heart Valve Prosthesis Implantation / adverse effects*,  instrumentation
Prosthesis-Related Infections / diagnosis*,  etiology,  surgery,  ultrasonography
Treatment Outcome
Reg. No./Substance:
0/Anti-Bacterial Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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