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Redo cardiac surgery for active prosthetic valve endocarditis associated with hereditary hemorrhagic telangiectasia: report of a case.

Nakamura Y, Shikata F, Ryugo M, Okamura T, Yasugi T, Izutani H - Surg. Today (2014)

Bottom Line: Hereditary hemorrhagic telangiectasia (HHT) is caused by an autosomal dominant gene and characterized by multiple arteriovenous malformations in several organs, leading to bleeding or shunting.These patients often suffer severe infections and heart failure, which should be managed in the perioperative period, when open heart surgery is indicated.We report a case of successful aortic root replacement for active prosthetic valve endocarditis and ventricular septal perforation in a patient with HHT, who had severe heart failure.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiovascular Surgery, Ehime University Hospital, Shitsukawa, Toon, Ehime, 791-0295, Japan, yukihtky@yahoo.co.jp.

ABSTRACT
Hereditary hemorrhagic telangiectasia (HHT) is caused by an autosomal dominant gene and characterized by multiple arteriovenous malformations in several organs, leading to bleeding or shunting. These patients often suffer severe infections and heart failure, which should be managed in the perioperative period, when open heart surgery is indicated. We report a case of successful aortic root replacement for active prosthetic valve endocarditis and ventricular septal perforation in a patient with HHT, who had severe heart failure.

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Related in: MedlinePlus

Preoperative computed tomography showed a dilated ascending aorta
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Fig3: Preoperative computed tomography showed a dilated ascending aorta

Mentions: About 1 year prior to the present admission for the fever and recurrent epistaxis, nasal mucosal telangiectasia had appeared, followed by the increased frequency of epistaxis. Blood cultures indicated the presence of methicillin-sensitive Staphylococcus epidermidis and echocardiogram showed prosthetic valve dysfunction with aortic regurgitation and vegetation. Despite intravenous antibiotics, congestive heart failure ensued. We administered diuretics and inotropes to maintain a satisfactory blood pressure and she was transferred to the intensive care unit (ICU) to improve her general condition. Her second echocardiogram showed evidence of ventricular septal perforation, a swaying prosthetic valve (Fig. 1a, b), and severe tricuspid regurgitation. The pressure gradient across the tricuspid valve was 54 mmHg. Chest radiography suggested congestive heart failure (Fig. 2). On preoperative computed tomography, the diameter of the ascending aorta was 52 mm (Fig. 3). Her progressive congestive heart failure and uncontrollable PVE warranted emergency surgery. Before the surgery, her condition stabilized without the need for intra-aortic balloon pumping (IABP) and tracheal intubation.Fig. 1


Redo cardiac surgery for active prosthetic valve endocarditis associated with hereditary hemorrhagic telangiectasia: report of a case.

Nakamura Y, Shikata F, Ryugo M, Okamura T, Yasugi T, Izutani H - Surg. Today (2014)

Preoperative computed tomography showed a dilated ascending aorta
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4231213&req=5

Fig3: Preoperative computed tomography showed a dilated ascending aorta
Mentions: About 1 year prior to the present admission for the fever and recurrent epistaxis, nasal mucosal telangiectasia had appeared, followed by the increased frequency of epistaxis. Blood cultures indicated the presence of methicillin-sensitive Staphylococcus epidermidis and echocardiogram showed prosthetic valve dysfunction with aortic regurgitation and vegetation. Despite intravenous antibiotics, congestive heart failure ensued. We administered diuretics and inotropes to maintain a satisfactory blood pressure and she was transferred to the intensive care unit (ICU) to improve her general condition. Her second echocardiogram showed evidence of ventricular septal perforation, a swaying prosthetic valve (Fig. 1a, b), and severe tricuspid regurgitation. The pressure gradient across the tricuspid valve was 54 mmHg. Chest radiography suggested congestive heart failure (Fig. 2). On preoperative computed tomography, the diameter of the ascending aorta was 52 mm (Fig. 3). Her progressive congestive heart failure and uncontrollable PVE warranted emergency surgery. Before the surgery, her condition stabilized without the need for intra-aortic balloon pumping (IABP) and tracheal intubation.Fig. 1

Bottom Line: Hereditary hemorrhagic telangiectasia (HHT) is caused by an autosomal dominant gene and characterized by multiple arteriovenous malformations in several organs, leading to bleeding or shunting.These patients often suffer severe infections and heart failure, which should be managed in the perioperative period, when open heart surgery is indicated.We report a case of successful aortic root replacement for active prosthetic valve endocarditis and ventricular septal perforation in a patient with HHT, who had severe heart failure.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiovascular Surgery, Ehime University Hospital, Shitsukawa, Toon, Ehime, 791-0295, Japan, yukihtky@yahoo.co.jp.

ABSTRACT
Hereditary hemorrhagic telangiectasia (HHT) is caused by an autosomal dominant gene and characterized by multiple arteriovenous malformations in several organs, leading to bleeding or shunting. These patients often suffer severe infections and heart failure, which should be managed in the perioperative period, when open heart surgery is indicated. We report a case of successful aortic root replacement for active prosthetic valve endocarditis and ventricular septal perforation in a patient with HHT, who had severe heart failure.

Show MeSH
Related in: MedlinePlus