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Infective endocarditis with myocardial abscesses complicating percutaneous transluminal coronary angioplasty
Toshihiko Shibata1, Hidekazu Hirai, Hiromichi Fujii
1Department of Cardiovascular Surgery, Osaka City University Medical School, Osaka, Abeno, Japan.
Insights
Staphylococcus aureus infectious endocarditis can lead to severe heart failure and myocardial infarction due to embolic vegetation. This case highlights the risk of multiple abscess formation in patients with severe ventricular dysfunction.
Area of Science:
- Cardiology
- Infectious Diseases
- Pathology
Background:
- Infectious endocarditis is a serious infection affecting heart valves.
- Staphylococcus aureus is a common causative agent, particularly in patients with prosthetic devices or prior interventions.
- Severe ventricular dysfunction can complicate the clinical course.
Purpose of the Study:
- To report a case of Staphylococcus aureus infectious endocarditis with severe complications.
- To emphasize the potential for myocardial microabscess formation and infarction in this context.
- To highlight the importance of recognizing severe ventricular dysfunction as a risk factor.
Main Methods:
- Case report of a 73-year-old male patient.
- Clinical presentation including percutaneous transluminal coronary angioplasty history.
- Diagnostic tools: Echocardiography, electrocardiography, laboratory tests.
- Intervention: Aortic valve replacement.
- Post-mortem examination.
Main Results:
- Development of Staphylococcus aureus infectious endocarditis post-percutaneous transluminal coronary angioplasty.
- Echocardiography showed aortic valve vegetations and severe aortic regurgitation.
- Progressive heart failure necessitated endotracheal intubation.
- Post-mortem revealed multiple myocardial microabscesses and myocardial infarction from embolic vegetation.
- Patient could not be weaned off cardiopulmonary bypass and died.
Conclusions:
- Severe ventricular dysfunction in infectious endocarditis increases the risk of myocardial microabscesses and infarction.
- Embolic phenomena from vegetations can lead to significant cardiac damage.
- Prompt recognition and management of infectious endocarditis, especially with pre-existing cardiac conditions, are crucial.
Abstract:
A 73-year-old man who had undergone percutaneous transluminal coronary angioplasty developed infectious endocarditis caused by Staphylococcus aureus. Echocardiography revealed vegetations of the aortic valve and severe aortic regurgitation. Endotracheal intubation was required for progressive heart failure. Serum creatinine kinase was elevated (411 IU/l: normal 30 to 140 IU/l). Electrocardiography showed no ischemic changes. Aortic replacement was performed to treat progressive heart failure, but the patient could not be weaned off cardiopulmonary bypass and subsequently died. A post-mortem examination revealed multiple myocardial microabscesses and myocardial infarction due to embolic vegetation. The possibility of multiple abscess formation when severe ventricle dysfunction occurs in infectious endocarditis is emphasized.