A 50-year-old female patient with visual disturbances was referred for further evaluation of a heart murmur. Fundoscopy revealed a Roth spot in both eyes. A physical examination showed peripheral signs of infective endocarditis, including Osler nodes, Janeway lesions, and splinter hemorrhages. Our preoperative diagnosis was subacute bacterial endocarditis with severe aortic regurgitation. The patient underwent aortic valve replacement and was treated with intravenous antibiotics for 6 weeks postoperatively. The patient made a remarkable recovery and was discharged without complications. We report this case of subacute endocarditis with all 4 classic peripheral signs in a patient who presented with visual disturbance.
Anti-Bacterial Agents ; Aortic Valve ; Aortic Valve Insufficiency ; Diagnosis ; Endocarditis ; Endocarditis, Subacute Bacterial* ; Female ; Heart Murmurs ; Hemorrhage ; Humans ; Middle Aged ; Physical Examination

Acetamides ; therapeutic use ; Aged ; Anti-Infective Agents ; therapeutic use ; Endocarditis, Subacute Bacterial ; drug therapy ; Humans ; Linezolid ; Male ; Oxazolidinones ; therapeutic use ; Treatment Outcome

BACKGROUND: Therapeutic plasma exchange (TPE) is a procedure by which plasma is removed from whole blood and this can be used in the treatment of some renal diseases. METHODS: We reviewed the medical records for the chief complaints, underlying diseases, clinical courses and treatment outcomes of 23 patients who had been treated with TPE at the Renal Division of Chungnam National University Hospital from January 1995 to June 2005. RESULTS: Patients with thrombotic thrombocytopenic purpura (TTP), microcopic polyangitis, lupus nephritis, hyperacute humoral rejection after kidney trasnplantation and rapidly progressive glomerulonephritis (RPGN) secondary to subacute bacterial endocarditis were included in this study. Among the 11 patients with TTP, six patients improved and two patients progressed to end-stage renal disease (ESRD). Three patients with TTP died. Seven patients with microscopic polyangitis and two patients with lupus nephritis had pulmonary hemorrhage at the time of TPE. Eight of the 11 TTP patients showed improvement of their pulmonary hemorrhage after TPE. One of the two patients with hyperacute humoral rejection after kidney transplantation and one patient with secondary RPGN were improved after TPE. Hypotension (three cases) was the most common adverse effect of TPE, followed by two cases of itching sensation and one case of fever with chills. CONCLUSIONS: Therapeutic plasma exchange was an effective treatment for patients with TTP, microscopic polyangitis, lupus nephritis with pulmonary hemorrhage and hyperacute humoral rejection after kidney transplantation.
Chills ; Chungcheongnam-do ; Endocarditis, Subacute Bacterial ; Fever ; Glomerulonephritis ; Hemorrhage ; Humans ; Hypotension ; Kidney ; Kidney Failure, Chronic ; Kidney Transplantation ; Lupus Nephritis ; Medical Records ; Plasma Exchange* ; Plasma* ; Pruritus ; Purpura, Thrombotic Thrombocytopenic ; Sensation

BACKGROUND: Sinus valsalva aneurysm (SVA) is a rare disease, and it is frequently accompanied by ventricular septal defect and aortic valve regurgitaion. For treatment of SVA, several surgical mordalities were applied, but there was no report on the long-term result after surgical repair in Korea. We reviewed our 28 years of experiences and analyzed the long-term results after treatment of sinus valsalva aneurysm with or without rupture. MATERIAL AND METHOD: Between March 1974 and February 2002, 81 patients were operated under the impression of sinus valvsalva aneurysm or sinus valsalva aneurym rupture. Retrospectively we reviewed the patients' record. Mean age of patients was 29.2+/-11.5 and there were 49 males. Accompanyng diseases were as follows: VSD in 50, PDA in 2, Behcet's disease in 2, TOF in 1, RVOTO in 1, AAE in 1. Seventy-seven (95%) patients had sinus valsalva rupture and in 14 patients, subacute bacterial endocarditis was accompanied. Degree of aortic valve regurgitation was as follows: grade I: 8, II: 10, III: 9, IV: 4. Most common rupture site was right coronary sinus (66 patients, 81%) and most common communication site was right ventricle (53 patients). In repair of sinus valsalva rupture, patch was used in 37 patients, and direct suture was done in 38 patients. RESULT: There was one surgical death (1.2%). Follow up was done in 78 patients (97.5%), mean follow up period was 123.3+/-80.9 (3~330 months). During the follow up period, 3 patients died (3.8%). One patient died of heart failure, another patient died of arrhythmia and the other one died of unknown cause. In two patients, complete atrio-ventricular block was developed during follow up period, and there was no operation related event or complication. Kaplan-Meier survival analysis revealed 92.5+/-3.5% survival at 15 and 27 years and it seems to be satisfactory. CONCLUSION: Long-term surgical results and survival is satisfactory after repair of sinus valsalva aneurysm with or without rupture.
Aneurysm* ; Aortic Valve ; Arrhythmias, Cardiac ; Coronary Sinus ; Endocarditis, Subacute Bacterial ; Follow-Up Studies ; Heart Failure ; Heart Septal Defects, Ventricular ; Heart Ventricles ; Humans ; Korea ; Male ; Rare Diseases ; Retrospective Studies ; Rupture* ; Sinus of Valsalva ; Sutures

Transient bacteremia associated with various endoscopic procedures is a well-documented phenomenon. Clinically important bacteremias are very rarely seen, however, this malady has significant morbidity in susceptible patients with valvular heart disease, liver cirrhosis, malignancy and immune deficiency. This bacteremia is a complication that is generally observed secondary to upper endoscopy and other associated invasive procedures in at risk patients, and the more serious manifestations include spontaneous bacterial peritonitis, septic arthritis, meningitis, brain abscess and infective endocarditis. Infective endocarditis is an extremely rare complication of gastrointestinal endoscopy, and it has been convincingly documented in only seven cases. We report a case of native valve endocarditis due to Streptococcus intermedius in a patient with valvular heart disease as a consequence of routine upper endoscopy.
Endocarditis, Subacute Bacterial/*etiology ; Endoscopy, Gastrointestinal/*adverse effects ; Female ; Humans ; Middle Aged ; Streptococcal Infections/*etiology ; Streptococcus intermedius/*isolation & purification

BACKGROUND: As the rupture of chordae and/or papillary muscle became the main cause of mitral valve regurgitation, mitral reconstructive surgery has a very important role. In this regard, we analyzed the clinical result and postoperative early result of operative treatment performed in our hospital. MATERIAL ANDMETHOD: For this analysis, forty nine patients (male 26, female 23, mean age 49.0+/-16.5) who underwent mitral valve operation caused by the rupture of chordae and/or papillary muscle from August 1991 to April 2002 were reviewed. Among forty nine patients, twenty two (44.9%) received mital valve reconstruction and twenty seven (59.2%) received mitral valve replacement. RESULT: As to the pathological etiology of rupture of mitral and papillary muscle, twenty five cases (51.0%) were nonspecific degeneration, eleven cases (22.4%) were myxomatous degeneration, seven cases (14.3%) were subacute bacterial endocarditis. Three patients suffered mortality after operation (6.1%) and valve replacement was performed again on one patient because of remnant mitral insufficiency after valve reconstruction. The 5-year survival rate after operation for the entire mitral valve regurgitation patients was 81.4%. We have also compared and analyzed the operation results of a group of patients who underwent valve reconstruction and the other group of patients who underwent valve replacement from thirty six patients who had suffered from mitral valve regurgitation caused by degenerative disease. The mortalities were 0% and 14.3%, respectively and the 5-year survival rates were 90.2% and 64.3%, respectively, but there were no statistical significance. CONCLUSION: The most common pathological etiology of mitral valve regurgitation caused by rupture of chordae and/or papillary muscle was nonspecific degeneration. In case of degenerative disease is the cause of mitral valve regurgitation, valve reconstruction showed better long-term effects in many respects and better operation results compared to valve replacement.
Endocarditis, Subacute Bacterial ; Female ; Humans ; Mitral Valve Insufficiency* ; Mitral Valve* ; Mortality ; Papillary Muscles* ; Rupture* ; Survival Rate

Infectious complications are the leading causes of morbidity and mortality among kidney transplant recipients. Infective endocarditis has been reported as a rare complication in kidney transplant recipients and substantially impacts kidney transplant recipient survival. The early diagnosis of endocarditis is essential in order to initiate appropriate antibiotic treatment. In selected cases, surgery can be undertaken to prevent significant subsequent morbidity and mortality. We report a case of subacute bacterial endocarditis due to beta- hemolytic streptococcus in a 25-year-old kidney transplant recipient, which was successfully treated with antibiotics and valve annuloplasty.
Adult ; Anti-Bacterial Agents ; Early Diagnosis ; Endocarditis* ; Endocarditis, Subacute Bacterial ; Humans ; Kidney ; Kidney Transplantation ; Mortality ; Streptococcus ; Transplantation*

Listerial endocarditis is rare disease with about 60 reported cases in the literatures. Although the clinical and laboratory features of listerial endocarditis are similar to those of subacute bacterial endocarditis caused by other pathogens, the incidence of complications and mortality rates are high. Early diagnosis, adequate treatment, and timely surgery are important for the better outcome. We report a case of a 62 year-old male with prosthetic valve endocarditis caused by Listeria monocytogenes, who was successfully treated with antibiotics and surgery (aortic valve and mitral valve re-replacement).
Anti-Bacterial Agents ; Early Diagnosis ; Endocarditis* ; Endocarditis, Subacute Bacterial ; Humans ; Incidence ; Listeria monocytogenes* ; Listeria* ; Male ; Middle Aged ; Mitral Valve ; Mortality ; Rare Diseases

Once splinter hemorrhage can be considered as a pathognomonic sign of subacute bacterial endocarditis. But it can also be associated with a variety of systemic disorders that increase capillary fragility or primary nail bed involvement in dermatologic disorders. The cause of splinter hemorrhage can usually be established by careful history and physical examination. We report a case of 33-year-old man with splinter hemorrhages, who had polycythemia vera.
Adult ; Capillary Fragility ; Endocarditis, Subacute Bacterial ; Hemorrhage* ; Humans ; Physical Examination ; Polycythemia Vera* ; Polycythemia*

A 30-year-old man was transferred to Yonsei Cardiovascular Hospital after 20 days of hospitalization under the diagnosis of bacterial endocarditis with mitral regurgitation and septic splenic infarct. He had suffered from intermittent high fever and general weakness for 3 months. Echocardiogram showed moderate mitral regurgitation and multiple large vegetations in both leaflets. Streptococcus viridans was confirmed by blood cultures, and administration of cefazoline and gentamycin was initiated. During the antibiotic therapy, abdominal and left calf pain developed, and abdominal computed tomography showed splenic and right renal infarct. He also complained intermittent headache and visual distrubance. Brain computed tomography and four vessels angiography showed a small aneurysm in right hemisphere and other small aneurysm in fronto-occipital area of left middle cerebral artery. No more systemic embolization developed until the completion of six weeks of antibiotic therapy. The patient underwent mitral valve replacement with #29 Carpenitier-Edwards Bioprosthesis. At operation, the anterior and posterior mitral leaflets were found perforated and covered with leaflets were found perforated and covered with multiple vegetations. Follow-up cerebral angiography taken at seventh postoperative day, showed enlargement of cerebral aneurysm. Clipping of saccular aneurysms on left M3 and M4 were performed and complete resolution of aneurysm was confirmed by brain computed tomography. On operative finding, an aneurysm was found on with saccular type. The patient was dischanged without complication on eighth postoperative day.
Adult ; Aneurysm ; Aneurysm, Infected* ; Angiography ; Bioprosthesis ; Brain ; Cefazolin ; Cerebral Angiography ; Diagnosis ; Endocarditis, Bacterial ; Endocarditis, Subacute Bacterial* ; Fever ; Follow-Up Studies ; Gentamicins ; Headache ; Hospitalization ; Humans ; Intracranial Aneurysm ; Middle Cerebral Artery ; Mitral Valve ; Mitral Valve Insufficiency ; Viridans Streptococci