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Timing for Pacing after Acquired Conduction Disease in the Setting of Endocarditis

A 53-year-old gentleman with a history of a mechanical aortic valve presented to the emergency department complaining of a sudden right-sided abdominal pain. He was found to have atrioventricular dissociation on his initial electrocardiogram and his blood cultures grew Streptococcus viridans. The su...

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Autores principales: Brancheau, Daniel, Degheim, George, Machado, Christian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi Publishing Corporation 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4300147/
https://www.ncbi.nlm.nih.gov/pubmed/25628898
http://dx.doi.org/10.1155/2015/471046
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author Brancheau, Daniel
Degheim, George
Machado, Christian
author_facet Brancheau, Daniel
Degheim, George
Machado, Christian
author_sort Brancheau, Daniel
collection PubMed
description A 53-year-old gentleman with a history of a mechanical aortic valve presented to the emergency department complaining of a sudden right-sided abdominal pain. He was found to have atrioventricular dissociation on his initial electrocardiogram and his blood cultures grew Streptococcus viridans. The suspicion for endocarditis with periaortic abscess was high so a transthoracic echocardiogram was performed and showed a mass in the left ventricular outflow tract. For better visualization, a transesophageal echocardiogram was recommended and revealed a bileaflet mechanical aortic valve with perivalvular abscess and valvular vegetation as well as severe eccentric paravalvular aortic regurgitation. After sterilization, the patient underwent a successful surgery. Postoperatively, he remained in complete heart block and a permanent pacemaker placement was performed after complete sterilization. He tolerated the procedure well and was discharged home in a stable condition. Perivalvular abscess is one of the most common cardiac complications of infective endocarditis and is associated with an increased risk of mortality. It is imperative to have appropriate treatment guidelines established. However, because of the relative nature of the disease process and the acuity at which intervention needs to be done, a true assessment of the duration of antibiotic therapy prior to surgical intervention, timing of pacemaker placement, and the type of pacemaker is controversial.
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spelling pubmed-43001472015-01-27 Timing for Pacing after Acquired Conduction Disease in the Setting of Endocarditis Brancheau, Daniel Degheim, George Machado, Christian Case Rep Cardiol Case Report A 53-year-old gentleman with a history of a mechanical aortic valve presented to the emergency department complaining of a sudden right-sided abdominal pain. He was found to have atrioventricular dissociation on his initial electrocardiogram and his blood cultures grew Streptococcus viridans. The suspicion for endocarditis with periaortic abscess was high so a transthoracic echocardiogram was performed and showed a mass in the left ventricular outflow tract. For better visualization, a transesophageal echocardiogram was recommended and revealed a bileaflet mechanical aortic valve with perivalvular abscess and valvular vegetation as well as severe eccentric paravalvular aortic regurgitation. After sterilization, the patient underwent a successful surgery. Postoperatively, he remained in complete heart block and a permanent pacemaker placement was performed after complete sterilization. He tolerated the procedure well and was discharged home in a stable condition. Perivalvular abscess is one of the most common cardiac complications of infective endocarditis and is associated with an increased risk of mortality. It is imperative to have appropriate treatment guidelines established. However, because of the relative nature of the disease process and the acuity at which intervention needs to be done, a true assessment of the duration of antibiotic therapy prior to surgical intervention, timing of pacemaker placement, and the type of pacemaker is controversial. Hindawi Publishing Corporation 2015 2015-01-06 /pmc/articles/PMC4300147/ /pubmed/25628898 http://dx.doi.org/10.1155/2015/471046 Text en Copyright © 2015 Daniel Brancheau et al. https://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Brancheau, Daniel
Degheim, George
Machado, Christian
Timing for Pacing after Acquired Conduction Disease in the Setting of Endocarditis
title Timing for Pacing after Acquired Conduction Disease in the Setting of Endocarditis
title_full Timing for Pacing after Acquired Conduction Disease in the Setting of Endocarditis
title_fullStr Timing for Pacing after Acquired Conduction Disease in the Setting of Endocarditis
title_full_unstemmed Timing for Pacing after Acquired Conduction Disease in the Setting of Endocarditis
title_short Timing for Pacing after Acquired Conduction Disease in the Setting of Endocarditis
title_sort timing for pacing after acquired conduction disease in the setting of endocarditis
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4300147/
https://www.ncbi.nlm.nih.gov/pubmed/25628898
http://dx.doi.org/10.1155/2015/471046
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