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Complicated Native Aortic Valve Endocarditis: Complexities of Medical Optimisation Prior to Surgical Repair for Large Vegetations With Systemic Emboli

A 43-year-old male with no history of valvular disease but ongoing intravenous drug use presented with acute confusion, pyrexia, and Osler’s nodes. Transthoracic echocardiography uncovered a large 17 x 15 mm-sized vegetation on the aortic valve, causing moderate-to-severe aortic regurgitation. Subse...

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Detalles Bibliográficos
Autores principales: Jullian, Lucas, Davies, Josh, Zafar, Mansoor, Senthivel, Mithilaa, Alkhoury, Jad
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10466259/
https://www.ncbi.nlm.nih.gov/pubmed/37654960
http://dx.doi.org/10.7759/cureus.42718
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author Jullian, Lucas
Davies, Josh
Zafar, Mansoor
Senthivel, Mithilaa
Alkhoury, Jad
author_facet Jullian, Lucas
Davies, Josh
Zafar, Mansoor
Senthivel, Mithilaa
Alkhoury, Jad
author_sort Jullian, Lucas
collection PubMed
description A 43-year-old male with no history of valvular disease but ongoing intravenous drug use presented with acute confusion, pyrexia, and Osler’s nodes. Transthoracic echocardiography uncovered a large 17 x 15 mm-sized vegetation on the aortic valve, causing moderate-to-severe aortic regurgitation. Subsequent multi-organ compromise and complexities regarding treatment adherence delayed surgical intervention; thus, six weeks of antibiotic therapy and medical optimisation, in close collaboration with cardiology, microbiology, and cardiothoracic teams, enabled definitive aortic valve repair to be performed. This case highlights the challenges encountered when managing this life-threatening condition and the obstacles of enacting the guidelines recommendations regarding the timing of surgical intervention. Our case portrays the effectiveness of medical management as bridge-to-surgery in patients not in a position to undergo immediate surgical repair.
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spelling pubmed-104662592023-08-31 Complicated Native Aortic Valve Endocarditis: Complexities of Medical Optimisation Prior to Surgical Repair for Large Vegetations With Systemic Emboli Jullian, Lucas Davies, Josh Zafar, Mansoor Senthivel, Mithilaa Alkhoury, Jad Cureus Cardiology A 43-year-old male with no history of valvular disease but ongoing intravenous drug use presented with acute confusion, pyrexia, and Osler’s nodes. Transthoracic echocardiography uncovered a large 17 x 15 mm-sized vegetation on the aortic valve, causing moderate-to-severe aortic regurgitation. Subsequent multi-organ compromise and complexities regarding treatment adherence delayed surgical intervention; thus, six weeks of antibiotic therapy and medical optimisation, in close collaboration with cardiology, microbiology, and cardiothoracic teams, enabled definitive aortic valve repair to be performed. This case highlights the challenges encountered when managing this life-threatening condition and the obstacles of enacting the guidelines recommendations regarding the timing of surgical intervention. Our case portrays the effectiveness of medical management as bridge-to-surgery in patients not in a position to undergo immediate surgical repair. Cureus 2023-07-31 /pmc/articles/PMC10466259/ /pubmed/37654960 http://dx.doi.org/10.7759/cureus.42718 Text en Copyright © 2023, Jullian et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Cardiology
Jullian, Lucas
Davies, Josh
Zafar, Mansoor
Senthivel, Mithilaa
Alkhoury, Jad
Complicated Native Aortic Valve Endocarditis: Complexities of Medical Optimisation Prior to Surgical Repair for Large Vegetations With Systemic Emboli
title Complicated Native Aortic Valve Endocarditis: Complexities of Medical Optimisation Prior to Surgical Repair for Large Vegetations With Systemic Emboli
title_full Complicated Native Aortic Valve Endocarditis: Complexities of Medical Optimisation Prior to Surgical Repair for Large Vegetations With Systemic Emboli
title_fullStr Complicated Native Aortic Valve Endocarditis: Complexities of Medical Optimisation Prior to Surgical Repair for Large Vegetations With Systemic Emboli
title_full_unstemmed Complicated Native Aortic Valve Endocarditis: Complexities of Medical Optimisation Prior to Surgical Repair for Large Vegetations With Systemic Emboli
title_short Complicated Native Aortic Valve Endocarditis: Complexities of Medical Optimisation Prior to Surgical Repair for Large Vegetations With Systemic Emboli
title_sort complicated native aortic valve endocarditis: complexities of medical optimisation prior to surgical repair for large vegetations with systemic emboli
topic Cardiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10466259/
https://www.ncbi.nlm.nih.gov/pubmed/37654960
http://dx.doi.org/10.7759/cureus.42718
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