Pub Date : 2018-09-12DOI: 10.5772/INTECHOPEN.79758
A. Fayaz, M. Nashy, S. Eapen, M. Firstenberg
The management of infections of the cardiac structures—specifically native heart valves— remains a difficult clinical challenge. Patients often present with a systemic infection that is made worse by embolic complications, such as strokes, along with pathophysiologic sequelae of acute valvular dysfunction. The timing of interventions has a significant impact on short- and long-term outcomes. The challenges and management decisions are even more complex when the infection involves a prosthetic valve—as risks of reopera tive cardiac surgery can be substantial. The goal of this chapter is to discuss the history of prosthetic valve endocarditis, review the current literature on the management of specific valvular involvement (i.e., aortic and/or mitral), and illustrate the challenging problems and outcomes that drive clinical decision making. While many of the indications for sur gery are similar to those associated with native valve infections, there is increased risk with reoperative surgery, often difficulties in clearing infection due to prosthetic material being in place. Unfortunately, antibiotics alone are not always effective, and frequent communications between the cardiac surgeon and infectious disease physicians are often necessary to find the “sweet spot” to perform the surgery.
{"title":"Prosthetic Valve Endocarditis","authors":"A. Fayaz, M. Nashy, S. Eapen, M. Firstenberg","doi":"10.5772/INTECHOPEN.79758","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.79758","url":null,"abstract":"The management of infections of the cardiac structures—specifically native heart valves— remains a difficult clinical challenge. Patients often present with a systemic infection that is made worse by embolic complications, such as strokes, along with pathophysiologic sequelae of acute valvular dysfunction. The timing of interventions has a significant impact on short- and long-term outcomes. The challenges and management decisions are even more complex when the infection involves a prosthetic valve—as risks of reopera tive cardiac surgery can be substantial. The goal of this chapter is to discuss the history of prosthetic valve endocarditis, review the current literature on the management of specific valvular involvement (i.e., aortic and/or mitral), and illustrate the challenging problems and outcomes that drive clinical decision making. While many of the indications for sur gery are similar to those associated with native valve infections, there is increased risk with reoperative surgery, often difficulties in clearing infection due to prosthetic material being in place. Unfortunately, antibiotics alone are not always effective, and frequent communications between the cardiac surgeon and infectious disease physicians are often necessary to find the “sweet spot” to perform the surgery.","PeriodicalId":143513,"journal":{"name":"Advanced Concepts in Endocarditis","volume":"2226 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127472257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-09-12DOI: 10.5772/INTECHOPEN.76766
Vikas Yellapu, D. Ackerman, S. Longo, S. Stawicki
Septic embolism is a relatively common and potentially severe complication of infective endocarditis (IE). Septic emboli (SE), most often described as consisting of a combination of thrombus and infectious material—either bacterial or fungal—can be caused by hema- togenous spread from virtually any anatomic site; however, it most commonly originates from cardiac valves. During the past two decades there has been a confluence of various risk factors that, both alone and in combination, led to greater incidence of both IE and SE, including increasing population age, greater use of prosthetic valves, implantation of various intracardiac devices, escalating intravenous drug use, and the high incidence of healthcare associated infections with antibiotic resistant microorganisms. From a clini- cal standpoint, SE can present at any time during the course of IE and may even be the initial presenting sign. SE may affect virtually any location in the human body, but some organs (e.g., liver, spleen, brain) and anatomic regions (e.g., lower extremity) tend to be more frequently involved. The most important aspect of management involves prompt recognition and proactive therapeutic approach. Given the broad spectrum of clinical presentations, symptoms and complications, SE can be challenging to diagnose and treat. Following the identification of SE, appropriate antibiotic coverage should be immediately instituted followed by supportive and/or interventional management, depending on the severity of presentation and the associated complications. In this chapter we explore the pathophysiology, anatomic origins, diagnostic tools, therapeutic measures, and new developments in SE, focusing predominantly on bacterial infections of cardiac origin.
{"title":"Septic Embolism in Endocarditis: Anatomic and Pathophysiologic Considerations","authors":"Vikas Yellapu, D. Ackerman, S. Longo, S. Stawicki","doi":"10.5772/INTECHOPEN.76766","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.76766","url":null,"abstract":"Septic embolism is a relatively common and potentially severe complication of infective endocarditis (IE). Septic emboli (SE), most often described as consisting of a combination of thrombus and infectious material—either bacterial or fungal—can be caused by hema- togenous spread from virtually any anatomic site; however, it most commonly originates from cardiac valves. During the past two decades there has been a confluence of various risk factors that, both alone and in combination, led to greater incidence of both IE and SE, including increasing population age, greater use of prosthetic valves, implantation of various intracardiac devices, escalating intravenous drug use, and the high incidence of healthcare associated infections with antibiotic resistant microorganisms. From a clini- cal standpoint, SE can present at any time during the course of IE and may even be the initial presenting sign. SE may affect virtually any location in the human body, but some organs (e.g., liver, spleen, brain) and anatomic regions (e.g., lower extremity) tend to be more frequently involved. The most important aspect of management involves prompt recognition and proactive therapeutic approach. Given the broad spectrum of clinical presentations, symptoms and complications, SE can be challenging to diagnose and treat. Following the identification of SE, appropriate antibiotic coverage should be immediately instituted followed by supportive and/or interventional management, depending on the severity of presentation and the associated complications. In this chapter we explore the pathophysiology, anatomic origins, diagnostic tools, therapeutic measures, and new developments in SE, focusing predominantly on bacterial infections of cardiac origin.","PeriodicalId":143513,"journal":{"name":"Advanced Concepts in Endocarditis","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114601879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-09-12DOI: 10.5772/INTECHOPEN.74252
G. Madison, R. Golamari, Priyanka T. Bhattacharya
Endocarditis caused by Abiotrophia and Granulicatella species, formerly known as nutritionally variant streptococci (NVS) is rare. It is associated with increased complications such as heart failure, systemic emboli, valve replacement surgery, treatment failures and mortality. The diagnosis of these infections is challenging due to specific nutritional growth requirements although modern techniques such as 16S rRNA sequence analysis and Matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) are particularly useful. Penicillin resistance among these organisms is a growing problem. Penicillin and gentamicin combination or alternatively Vancomycin alone are the recommended treatment options, however there is increasing data regarding susceptibilities to other antibiotics. Varying susceptibilities to antibiotics among different species of NVS needs to be studied further.
{"title":"Endocarditis Caused by Abiotrophia and Granulicatella Species","authors":"G. Madison, R. Golamari, Priyanka T. Bhattacharya","doi":"10.5772/INTECHOPEN.74252","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.74252","url":null,"abstract":"Endocarditis caused by Abiotrophia and Granulicatella species, formerly known as nutritionally variant streptococci (NVS) is rare. It is associated with increased complications such as heart failure, systemic emboli, valve replacement surgery, treatment failures and mortality. The diagnosis of these infections is challenging due to specific nutritional growth requirements although modern techniques such as 16S rRNA sequence analysis and Matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) are particularly useful. Penicillin resistance among these organisms is a growing problem. Penicillin and gentamicin combination or alternatively Vancomycin alone are the recommended treatment options, however there is increasing data regarding susceptibilities to other antibiotics. Varying susceptibilities to antibiotics among different species of NVS needs to be studied further.","PeriodicalId":143513,"journal":{"name":"Advanced Concepts in Endocarditis","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122487223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-09-12DOI: 10.5772/INTECHOPEN.75760
J. Sedgwick, G. Scalia
This chapter provides an updated overview of the scientific literature on cardiac pathology predisposing to infective endocarditis and the estimated risk associated with selected lesion-specific abnormalities, in an era of changing epidemiology and advanced echocardiographic imaging. Importantly, with the evolution of modern-era echo, subtle changes in valve structure and function are now easily detectable and a proportion of cases of apparently ‘normal’ valves involved with IE, may in fact have subtle pre-existing pathological and/or haemodynamic abnormalities. The chapter will have a clinical focus with an aim to provide the Physician with up-to-date and practical information on cardiac risk factor identification for infective endocarditis.
{"title":"The Role of Modern-Era Echocardiography in Identification of Cardiac Risk Factors for Infective Endocarditis","authors":"J. Sedgwick, G. Scalia","doi":"10.5772/INTECHOPEN.75760","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.75760","url":null,"abstract":"This chapter provides an updated overview of the scientific literature on cardiac pathology predisposing to infective endocarditis and the estimated risk associated with selected lesion-specific abnormalities, in an era of changing epidemiology and advanced echocardiographic imaging. Importantly, with the evolution of modern-era echo, subtle changes in valve structure and function are now easily detectable and a proportion of cases of apparently ‘normal’ valves involved with IE, may in fact have subtle pre-existing pathological and/or haemodynamic abnormalities. The chapter will have a clinical focus with an aim to provide the Physician with up-to-date and practical information on cardiac risk factor identification for infective endocarditis.","PeriodicalId":143513,"journal":{"name":"Advanced Concepts in Endocarditis","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127128907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-09-12DOI: 10.5772/INTECHOPEN.76844
J. Aultman, Emanuela C. Peshel, Cyril Harfouche, M. Firstenberg
The treatment of patients with intravenous drug use (IVDU) has evolved to include a wide range of medications, psychiatric rehabilitation, and surgical interventions, especially for life-threatening complications such as infective endocarditis (IE). These interventions remain at the discretion of physicians, particularly surgeons, whose treatment decisions are influenced by several medical factors, unfortunately not with - out bias. The stigma associated with substance use disorder is prevalent, which leads to significant biases, even in the healthcare system. This bias is heightened when IVDU patients require repeat valve replacement surgeries for IE due to continued drug use. Patients who receive a valve replacement and continue to use illicit drugs intrave- nously often return to their medical providers, months to a few years later, with a reinfection of their bioprosthetic valve; such patients require additional surgeries which are at the center of many ethical discussions due to high mortality rates, for many complex medical and social reasons, associated with continuous chemical dependency after surgical interventions. This chapter examines the ethics of repeat heart valve replacement surgery for patients who are struggling with addiction. Considerations of justice, the fiduciary therapeutic relationship, and guiding ethical principles jus tify medically beneficial repeat heart valve replacement surgeries for IVDU patient populations.
{"title":"The Ethics in Repeat Heart Valve Replacement Surgery","authors":"J. Aultman, Emanuela C. Peshel, Cyril Harfouche, M. Firstenberg","doi":"10.5772/INTECHOPEN.76844","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.76844","url":null,"abstract":"The treatment of patients with intravenous drug use (IVDU) has evolved to include a wide range of medications, psychiatric rehabilitation, and surgical interventions, especially for life-threatening complications such as infective endocarditis (IE). These interventions remain at the discretion of physicians, particularly surgeons, whose treatment decisions are influenced by several medical factors, unfortunately not with - out bias. The stigma associated with substance use disorder is prevalent, which leads to significant biases, even in the healthcare system. This bias is heightened when IVDU patients require repeat valve replacement surgeries for IE due to continued drug use. Patients who receive a valve replacement and continue to use illicit drugs intrave- nously often return to their medical providers, months to a few years later, with a reinfection of their bioprosthetic valve; such patients require additional surgeries which are at the center of many ethical discussions due to high mortality rates, for many complex medical and social reasons, associated with continuous chemical dependency after surgical interventions. This chapter examines the ethics of repeat heart valve replacement surgery for patients who are struggling with addiction. Considerations of justice, the fiduciary therapeutic relationship, and guiding ethical principles jus tify medically beneficial repeat heart valve replacement surgeries for IVDU patient populations.","PeriodicalId":143513,"journal":{"name":"Advanced Concepts in Endocarditis","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122636086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-09-12DOI: 10.5772/INTECHOPEN.76767
M. Ebato
Blood culture-negative endocarditis is often severe and difficult to diagnose. Infective blood culture-negative endocarditis is classified into three main categories: (1) bacterial endocarditis with blood cultures sterilized by previous antibacterial treatment; (2) endocarditis related to fastidious microorganisms in which prolonged incubation is necessary; (3) true blood culture-negative endocarditis, due to intra-cellular bacteria that cannot be routinely cultured in blood with currently available. There are two major etiologies for noninfective endocarditis: (1) nonbacterial thrombotic endocarditis and (2) endocarditis related to systemic diseases (SLE and Behcet disease). Team approach including cardiologists, infection disease (ID) specialists, microbiologists, pathologist and immunologist is crucial for diagnosis and management of blood culture-negative endocarditis as it needs elegant and high-quality modern technics of histology, molecular analysis and essential epidemiological information.
{"title":"Blood Culture-Negative Endocarditis","authors":"M. Ebato","doi":"10.5772/INTECHOPEN.76767","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.76767","url":null,"abstract":"Blood culture-negative endocarditis is often severe and difficult to diagnose. Infective blood culture-negative endocarditis is classified into three main categories: (1) bacterial endocarditis with blood cultures sterilized by previous antibacterial treatment; (2) endocarditis related to fastidious microorganisms in which prolonged incubation is necessary; (3) true blood culture-negative endocarditis, due to intra-cellular bacteria that cannot be routinely cultured in blood with currently available. There are two major etiologies for noninfective endocarditis: (1) nonbacterial thrombotic endocarditis and (2) endocarditis related to systemic diseases (SLE and Behcet disease). Team approach including cardiologists, infection disease (ID) specialists, microbiologists, pathologist and immunologist is crucial for diagnosis and management of blood culture-negative endocarditis as it needs elegant and high-quality modern technics of histology, molecular analysis and essential epidemiological information.","PeriodicalId":143513,"journal":{"name":"Advanced Concepts in Endocarditis","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122711491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-09-12DOI: 10.5772/INTECHOPEN.76845
L. Iliuță
Aim: Defining the echographic parameters which can help in identifying the high-risk groups for embolic events (EE) in patients with infective endocarditis (IE). Material and method: 236 patients with IE followed up 3 years with ECO parameters measured on the vegetations (VEG). Results: (1) the incidence rate of the EE was 51.27% without any significant differences for EE occurrence from the point of view of clinical parameters. (2) There was a significant correlation between the embolia occurrence and IE with staphylococcus, IE of the right heart, the length and mobility of VEG. The only independent predictors for EE were: the maximum length >15 mm and the increased mobility of VEG with the maximal angle >60.7. (3) In 23.14% of the patients with big and very mobile, EE occurred after starting the antibiotic treatment. Conclusions: (1) the VEG dimension and mobility determined by TEE are important predictors for the prognostic and are cor- related with the embolic risk. (2) Significant ECO predictors of the EE occurrence were: VEG length >15 mm, neck/thickness ratio >0.69, and maximal angle of displacement of VEG in the cardiac cycle >60.7. (3) During the antibiotic treatment, the embolic risk depends only on VEG mobility and dimension.
{"title":"Prediction of Embolic Events in Infective Endocarditis Using Echocardiography","authors":"L. Iliuță","doi":"10.5772/INTECHOPEN.76845","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.76845","url":null,"abstract":"Aim: Defining the echographic parameters which can help in identifying the high-risk groups for embolic events (EE) in patients with infective endocarditis (IE). Material and method: 236 patients with IE followed up 3 years with ECO parameters measured on the vegetations (VEG). Results: (1) the incidence rate of the EE was 51.27% without any significant differences for EE occurrence from the point of view of clinical parameters. (2) There was a significant correlation between the embolia occurrence and IE with staphylococcus, IE of the right heart, the length and mobility of VEG. The only independent predictors for EE were: the maximum length >15 mm and the increased mobility of VEG with the maximal angle >60.7. (3) In 23.14% of the patients with big and very mobile, EE occurred after starting the antibiotic treatment. Conclusions: (1) the VEG dimension and mobility determined by TEE are important predictors for the prognostic and are cor- related with the embolic risk. (2) Significant ECO predictors of the EE occurrence were: VEG length >15 mm, neck/thickness ratio >0.69, and maximal angle of displacement of VEG in the cardiac cycle >60.7. (3) During the antibiotic treatment, the embolic risk depends only on VEG mobility and dimension.","PeriodicalId":143513,"journal":{"name":"Advanced Concepts in Endocarditis","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125680770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-03-05DOI: 10.5772/INTECHOPEN.74951
T. Murashita
Isolated tricuspid valve infective endocarditis is relatively rare. However, the frequency of tricuspid valve infective endocarditis in the United States is rapidly increasing, mainly due to the epidemic of intravenous drug use. A medical treatment is the first choice for this disease; however, surgical intervention is required when the patients suffer from heart failure, large vegetation, or persistent bacteremia despite appropriate medical treatment. Several techniques for tricuspid valve reconstruction have been proposed, and their outcomes have been reported to be good. However, in the cases of severe valve destruction, tricuspid valve replacement is required. Post-surgical management of drug-induced infective endocarditis is challenging due to its poor compliance to medication and high rate of reinfection. There is an ethical controversy as to surgical indication for reinfection induced by relapse of drug use. In addition, because reoperation for tricuspid valve carries high risk, there is also a controversy regarding valve choice in drug users.
{"title":"Surgical Treatment for Tricuspid Valve Infective Endocarditis","authors":"T. Murashita","doi":"10.5772/INTECHOPEN.74951","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.74951","url":null,"abstract":"Isolated tricuspid valve infective endocarditis is relatively rare. However, the frequency of tricuspid valve infective endocarditis in the United States is rapidly increasing, mainly due to the epidemic of intravenous drug use. A medical treatment is the first choice for this disease; however, surgical intervention is required when the patients suffer from heart failure, large vegetation, or persistent bacteremia despite appropriate medical treatment. Several techniques for tricuspid valve reconstruction have been proposed, and their outcomes have been reported to be good. However, in the cases of severe valve destruction, tricuspid valve replacement is required. Post-surgical management of drug-induced infective endocarditis is challenging due to its poor compliance to medication and high rate of reinfection. There is an ethical controversy as to surgical indication for reinfection induced by relapse of drug use. In addition, because reoperation for tricuspid valve carries high risk, there is also a controversy regarding valve choice in drug users.","PeriodicalId":143513,"journal":{"name":"Advanced Concepts in Endocarditis","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129850682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-02-23DOI: 10.5772/INTECHOPEN.74621
Marion J. Skalweit
Left ventricular assist device (LVAD) infections are important causes of morbidity and mortality in patients who receive these mechanical circulatory supports as a bridge to transplantation (BTT) or as destination therapy (DT) (for individuals who are not candi- dates for cardiac transplant). Infections are more common among persons who received pulsatile flow LVADs as opposed to newer continuous flow (CF) devices. Other risk fac - tors for infection include obesity, renal failure, depression and immunosuppression. An LVAD infection increases the risk of infections in persons who undergo cardiac trans - plantation. Infections include percutaneous site, driveline, pump pocket and pump/can nula infections; sepsis, bacteremia, mediastinitis and endocarditis. Diagnosis is achieved by monitoring LVAD flow parameters and observing typical clinical and laboratory man ifestations of infection. Imaging such as PET-CT or SPECT-CT imaging can be helpful to establish a diagnosis of pump pocket infection. Echocardiography may aid in detecting native valve endocarditis and thrombus associated with the LVAD. The most common pathogens include Staphylococcus , Corynebacterium , Enterococcus , Pseudomonas and Candida spp. Treatment requires targeted antimicrobials plus surgical debridement of infected tissue and device components. In cases of pump/cannula/LVAD endocarditis, especially if fungal pathogens or Mycobacterium chimaera are involved, LVAD removal/reimplanta tion transplant is with extended antimicrobial therapy.
{"title":"Left Ventricular Assist Device Infections","authors":"Marion J. Skalweit","doi":"10.5772/INTECHOPEN.74621","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.74621","url":null,"abstract":"Left ventricular assist device (LVAD) infections are important causes of morbidity and mortality in patients who receive these mechanical circulatory supports as a bridge to transplantation (BTT) or as destination therapy (DT) (for individuals who are not candi- dates for cardiac transplant). Infections are more common among persons who received pulsatile flow LVADs as opposed to newer continuous flow (CF) devices. Other risk fac - tors for infection include obesity, renal failure, depression and immunosuppression. An LVAD infection increases the risk of infections in persons who undergo cardiac trans - plantation. Infections include percutaneous site, driveline, pump pocket and pump/can nula infections; sepsis, bacteremia, mediastinitis and endocarditis. Diagnosis is achieved by monitoring LVAD flow parameters and observing typical clinical and laboratory man ifestations of infection. Imaging such as PET-CT or SPECT-CT imaging can be helpful to establish a diagnosis of pump pocket infection. Echocardiography may aid in detecting native valve endocarditis and thrombus associated with the LVAD. The most common pathogens include Staphylococcus , Corynebacterium , Enterococcus , Pseudomonas and Candida spp. Treatment requires targeted antimicrobials plus surgical debridement of infected tissue and device components. In cases of pump/cannula/LVAD endocarditis, especially if fungal pathogens or Mycobacterium chimaera are involved, LVAD removal/reimplanta tion transplant is with extended antimicrobial therapy.","PeriodicalId":143513,"journal":{"name":"Advanced Concepts in Endocarditis","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125966758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-02-11DOI: 10.5772/INTECHOPEN.73679
F. Vallejo
Before the antibiotic era and cardiac surgery, infective endocarditis (IE) was a predominantly fatal disease. In-hospital mortality persists relatively high despite development in medical and surgical treatment. Adequate timing and surgical management of the infected valve help prevent substantially early and late mortality. The surgical approach of mitral valve endocarditis should be based on extension of the disease and annular involvement. When the valve and annulus are severely affected, the best option is to perform a complete excision and mitral valve replacement (MVR). Only if the disease is limited to the valvular tissue, mitral valve repair is the preferred surgical option.
{"title":"Surgical Management of Mitral Valve Endocarditis","authors":"F. Vallejo","doi":"10.5772/INTECHOPEN.73679","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.73679","url":null,"abstract":"Before the antibiotic era and cardiac surgery, infective endocarditis (IE) was a predominantly fatal disease. In-hospital mortality persists relatively high despite development in medical and surgical treatment. Adequate timing and surgical management of the infected valve help prevent substantially early and late mortality. The surgical approach of mitral valve endocarditis should be based on extension of the disease and annular involvement. When the valve and annulus are severely affected, the best option is to perform a complete excision and mitral valve replacement (MVR). Only if the disease is limited to the valvular tissue, mitral valve repair is the preferred surgical option.","PeriodicalId":143513,"journal":{"name":"Advanced Concepts in Endocarditis","volume":"219 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130420380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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