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Severe cardiogenic shock due to acute onset of an aorto-to-right atrial shunt in a patient with aortic valve endocarditis.

Siebers C, Schramm R, Friedmann A, Weig T - Int J Surg Case Rep (2014)

Bottom Line: A 62-year-old man, who underwent aortic valve replacement five years previously, was admitted to ICU due to acute hemodynamic deterioration.A few days earlier, he had a septic episode with blood cultures positive for Staphylococcus aureus and clinical features of infective endocarditis.In ICU, transthoracic echocardiography revealed shunting from the aortic root to the right atrium resulting in severe cardiogenic shock.

View Article: PubMed Central - PubMed

Affiliation: Clinic of Anaesthesiology, University Hospital of Munich, Campus Großhadern, Munich, Germany. Electronic address: csiebers@med.lmu.de.

No MeSH data available.


Related in: MedlinePlus

Transthoracic echocardiography. Color Doppler revealed the newly detected aorto-right atrial shunt (arrow).
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fig0005: Transthoracic echocardiography. Color Doppler revealed the newly detected aorto-right atrial shunt (arrow).

Mentions: A 62-year-old, HIV positive, male patient, who underwent bioprosthetic aortic valve replacement five years previously, was admitted to an external hospital with sepsis. Blood cultures were positive for Staphylococcus aureus. Septic shock was accompanied with respiratory insufficiency and renal failure. No specific focus was found by an initial CT-scan of the chest and abdomen. A transesophageal echocardiography (TEE), performed upon admission, showed no endocarditis. Treatment with broad-spectrum antibiotics was initiated immediately. His clinical condition improved and the patient was discharged from ICU. Exactly one week after admission the patient developed symptoms of a stroke and CT detected a thromboembolism in the region of the posterior cerebral artery. Subsequent TEE, revealed a vegetation on the right coronary cusp of the aortic valve bioprothesis and an aortic root abscess. The patient was hemodynamically stable, so semi-elective surgical treatment was planned. His neurological symptoms declined during the following days. On day 12 after admission, however, acute deterioration of the patient's hemodynamic conditions required urgent transfer to our hospital. On admission to the intensive care unit the patient required high dose vasopressor therapy. Transthoracic echocardiography (TTE) showed hyperdynamic biventricular function and shunting from the aortic root to the right atrium (Fig. 1). Position, dimension and exact anatomic conditions of the fistula were obtained by contrast enhanced computed tomography (Fig. 2). Cardiac surgery was performed immediately. After removal of the bioprosthesis, a large periannular abscess opening into the right atrium was uncovered (Fig. 3). A pericardial patch plasty was performed to exclude the abscess and another to seal the right atrium interiorly. In addition, a new bioprosthesis was implanted. Postoperatively, his clinical status improved quickly and the patient left the ICU nineteen days after surgical treatment in stable physical condition and without any neurological deficit. Eight weeks after surgery he was discharged.


Severe cardiogenic shock due to acute onset of an aorto-to-right atrial shunt in a patient with aortic valve endocarditis.

Siebers C, Schramm R, Friedmann A, Weig T - Int J Surg Case Rep (2014)

Transthoracic echocardiography. Color Doppler revealed the newly detected aorto-right atrial shunt (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3921656&req=5

fig0005: Transthoracic echocardiography. Color Doppler revealed the newly detected aorto-right atrial shunt (arrow).
Mentions: A 62-year-old, HIV positive, male patient, who underwent bioprosthetic aortic valve replacement five years previously, was admitted to an external hospital with sepsis. Blood cultures were positive for Staphylococcus aureus. Septic shock was accompanied with respiratory insufficiency and renal failure. No specific focus was found by an initial CT-scan of the chest and abdomen. A transesophageal echocardiography (TEE), performed upon admission, showed no endocarditis. Treatment with broad-spectrum antibiotics was initiated immediately. His clinical condition improved and the patient was discharged from ICU. Exactly one week after admission the patient developed symptoms of a stroke and CT detected a thromboembolism in the region of the posterior cerebral artery. Subsequent TEE, revealed a vegetation on the right coronary cusp of the aortic valve bioprothesis and an aortic root abscess. The patient was hemodynamically stable, so semi-elective surgical treatment was planned. His neurological symptoms declined during the following days. On day 12 after admission, however, acute deterioration of the patient's hemodynamic conditions required urgent transfer to our hospital. On admission to the intensive care unit the patient required high dose vasopressor therapy. Transthoracic echocardiography (TTE) showed hyperdynamic biventricular function and shunting from the aortic root to the right atrium (Fig. 1). Position, dimension and exact anatomic conditions of the fistula were obtained by contrast enhanced computed tomography (Fig. 2). Cardiac surgery was performed immediately. After removal of the bioprosthesis, a large periannular abscess opening into the right atrium was uncovered (Fig. 3). A pericardial patch plasty was performed to exclude the abscess and another to seal the right atrium interiorly. In addition, a new bioprosthesis was implanted. Postoperatively, his clinical status improved quickly and the patient left the ICU nineteen days after surgical treatment in stable physical condition and without any neurological deficit. Eight weeks after surgery he was discharged.

Bottom Line: A 62-year-old man, who underwent aortic valve replacement five years previously, was admitted to ICU due to acute hemodynamic deterioration.A few days earlier, he had a septic episode with blood cultures positive for Staphylococcus aureus and clinical features of infective endocarditis.In ICU, transthoracic echocardiography revealed shunting from the aortic root to the right atrium resulting in severe cardiogenic shock.

View Article: PubMed Central - PubMed

Affiliation: Clinic of Anaesthesiology, University Hospital of Munich, Campus Großhadern, Munich, Germany. Electronic address: csiebers@med.lmu.de.

No MeSH data available.


Related in: MedlinePlus