ECHO 2013 / Clinical Decision Making Endocarditis and the Role of Echo
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TV endocarditis
Catheter related endocarditis
18 yo female with persistently positive blood cultures (+) MSSA s/p mediport removal.
SVC thrombus with superinfection.
Cardiac Device infective endocarditis
CDIEcommon and dangerous
•177/2760 with endocarditis with CDIE.
•Coexisting valve involvement in 43/177 (mostly TV)
•In hospital mortality: 14.7%,
•One year mortality 23.2%
•Valve involvement -->higher mortality Athan, et al. JAMA, April 25, 2012.
Cardiac Device Infective
endocarditisorganism
Antibiotic prophylaxis for dental work is not recommended, but pre implantation antibiotics is beneficial.
Baddour, et al. Update on Cardiovascular implantable electronic device infections.
Circulation 2010. 121:458-477.
Echo to help guide
treatment
Urgent surgical consideration
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Baddour, Circulation 2005:111
Systemic emboli
Vegetation >1.0cm on anterior MV
Fungal infection
Embolic event within first 2 weeks of abx
Increasing size of veg despite abx
Acute AI/MR with ventricular failure
Refractory CHF
Valve rupture/perforation/dehiscence/fistula
Large abscess or extension of abscess despite abx
Heart block (highly suggestive of abscess)
Clinical case
62 yo gentleman with MSSA bacteremia, severe dyspnea, multiple psoas abscesses, septic arthritis of hand, cellulitis of foot, mycotic aneurysm of SMA, acute infarctions of bilateral parietal lobes, thalamus, cerebellum.
TEE:19mm x15mm x 11mm vegetation on P1 with perforation
Urgent surgery with resection of vegetation and repair of valve
Perforation of both aortic and mitral valves