Anthony Alozie

Staged total percutaneous treatment of aortic valve pathology and mitral regurgitation: Institutional experience

To summarize our single Institution experience with staged total percutaneous management of aorto‐mitral pathology.

Surgical revision after percutaneous mitral valve repair by edge-to-edge device: when the strategy fails in the highest risk surgical population

OBJECTIVES Percutaneous edge-to-edge devices for non-surgical repair of mitral valve regurgitation are under clinical evaluation in high-risk patients deemed not suitable for conventional surgery. To address guidelines for initial therapy decision, we here report on 13 cases of surgery after failed percutaneous edge-to-edge mitral valve repair or attempted repair, and discuss methodology and prognostic factors for operative outcome in this high-risk situation. METHODS Thirteen patients referred to our cardiothoracic unit after failed percutaneous mitral valve repair or attempted repair using the edge-to-edge technique, were treated surgically for mitral valve failure between June 2010 and December 2012. Pathology of mitral valve before and after interventional mitral valve repair (especially prevalent mode of failure) was evaluated and classified for each individual patient by echocardiography and intraoperative direct visualization. Number of implanted edge-to-edge devices were identified. Preoperative risk scores were matched with intraoperative observations and histopathological findings of valve tissue. Postoperative morbidity and mortality were analysed with respect to mitral valve and patient-related data. RESULTS Three of 10 patients were referred with severe mitral valve regurgitation/stenosis after initially successful percutaneous edge-to-edge therapy or attempted therapy. In 3 patients, ≥ 2 edge-to-edge devices were implanted leading to very tight edge-to-edge leaflet connection and fibrosis. All patients underwent successful surgical mitral valve replacement and concomitant complete cardiac surgery (CABG, aortic or tricuspid valve surgery, ASD closure and pulmonary vein isolation for atrial fibrillation). The likelihood of repair was reduced with respect to multiple edge-to-edge technology. One device could not be harvested surgically because of embolization. One patient died on the second postoperative day due to sepsis with multiple organ failure. The remaining 12 patients were discharged with excellent valve prosthesis function and followed up to 2 years post-surgery. The current long-term survival rate is 77%. CONCLUSION Our series demonstrate that highest risk patients can survive mitral valve surgery after failed multiple edge-to-edge interventional mitral valve repair. As long-term results of the MitraClip therapy are pending, we recommend close meshed follow-up of patients treated with the MitraClip device, especially within the first year of the index procedure as delays in salvage management, interventional or surgical, when the index procedure fails may increase morbidity and mortality.

Culture-negative Infective Endocarditis of the Aortic Valve due to Aerococcus urinae: A Rare Aetiology

Bacteria of the species Aerococcus urinae are Gram-positive, catalase-negative cocci that are arranged in pairs, tetrads, or clusters resembling enterococci or staphylococci. They are rare causative agents of infective endocarditis. Repetitive urinary tract infections based upon underlying genitourinary tract abnormalities could involve these bacteria. Due to their similarity to other Gram-positive cocci misinterpretation may occur along the line of microbiologic differentiation, which could potentially lead to a fatal outcome. We herein report on the clinical course of a 68 year-old male patient who in the setting of an embolic stroke was initially diagnosed with a culture-negative acute infective endocarditis of the aortic valve.

Aorto: right atrial shunt due to perforated sinus of valsalva aneurysm in a young athlete: a rare congenital defect confirmed by various non-invasive imaging modalities

A 19-year-old athlete with sudden onset dyspnoea and progressive exercise intolerance presented to our Heart Centre for assessment of his cardiopulmonary function. A grade 3/6 continuous murmur best heard along the lower left sternal boarder was the only pathological finding upon physical examination. …

Embolization of multiple papillary fibroelastoma of the aortic valve as cause of a ST-segment elevation myocardial infarction

A 48-year-old man presented to a neighbouring cardiology unit with epigastric pain sensation. Acute myocardial infarction (AMI) was suggested by laboratory parameters for myocardial infarction and electrocardiogram showing ST-segment elevation in the inferior and lateral leads ( Panel G ). Emergency coronary angiogram revealed a subtotal occlusion of the posterolateral branch …

Awake Extracorporeal Membrane Oxygenation (ECMO) as Bridge to Recovery After Left Main Coronary Artery Occlusion: A Promising Concept of Haemodynamic Support in Cardiogenic Shock

Cardiogenic shock following acute myocardial infarction is associated with high mortality rate. Different management concepts including fluid management, inotropic support, intra aortic balloon counterpulsation (IABP) and extracorporeal membrane oxygenation (ECMO) mainly in mechanically ventilated patients have been used as cornerstones of management. However, success rates have been disappointing. Few reports suggested that ECMO when performed under circumvention of mechanical ventilation, may offer some survival benefits. We herein present our experience with the use of veno-arterial ECMO as bridge to recovery in an awake and spontaneously breathing patient after left main coronary artery occlusion complicated by cardiogenic shock.

Streptococcus bovis infectious endocarditis and occult gastrointestinal neoplasia: experience with 25 consecutive patients treated surgically

To assess the prevalence of gastrointestinal neoplasia in patients with Streptococcus bovis infectious endocarditis we performed a retrospective cohort analysis of all episodes of S. bovis infectious endocarditis treated at our institution between January 2000 through December 2014. Twenty-five patients were identified for this purpose. 12/25 patients received colonoscopy and 1/25 of the patients was assessed with CT colonography. Of the 13 who underwent colonic assessment, 11 were diagnosed with colonic neoplasms at different stages of development. In the absence of any strong contraindication, gastroenteroscopic evaluation in all patients diagnosed with S. bovis infectious endocarditis should be pursued.

Bartonella quintana endocarditis of the tricuspid and mitral valves.

Bartonella quintana is a gram-negative microorganism that can lead to culture-negative infective endocarditis (IE) in immunocompromised patients. Here, we present an exceptionally rare case of a 70-year-old male with Bartonella quintana-associated IE primarily limited to the tricuspid valve that spread to the mitral valve after tricuspid valve replacement. This was then complicated by infective spondylodiscitis of the thoracic vertebrae, ultimately resulting in death due to cardiac arrest.

Transient ischaemic attack due to the lead of an implantable defibrillator in the left heart

A frequently underdiagnosed complication of pacemaker and implantable cardioverter defibrillator lead implantation is the unintentional advancement of the leads into the systemic circulation. We report a case encountered in our clinic in a 70-year old man evaluated in a neighbouring clinic with symptoms of transient ischaemic attack with initially unclear aetiology. Posterior-anterior chest X-rays suggested that the lead was in the left heart. This finding was confirmed by transthoracic and transoesophageal echocardiography.

Single-stage hybrid repair of a mycotic lusorian artery aneurysm.

2 76-year-old man presented to our emergency department with recurrent episodes of fever, nausea, nd vomiting. Laboratory investigations revealed an eleated white blood cell count and increased levels of -reactive protein. His medical history was notable for he incidental finding of an aberrant right subclavian lusorian) artery. Repeated computed tomography demonstrated a ritical enlargement of the proximal lusorian artery to n actual size of 45 mm (Fig 1). Given the presumed xistence of a mycotic aneurysm, calculated antibiotic edication was established, resulting in prompt remision of associated clinical symptoms. Considering noralized paraclinical infectious parameters and reeated negative blood cultures, sterility of the neurysm was anticipated, and the patient eventually ualified for definite treatment of the lusorian lesion. fter delineation of the brain-supplying vasculature by agnetic resonance imaging, the patient was transerred to the hybrid suite for single-stage bilateral