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Postoperative dyspnoea.
Heart 2017; 103(5):367H

Abstract

CLINICAL INTRODUCTION

A man in his 50s presented with abscessed aortic valve methicillin-sensitive Staphylococcus aureus endocarditis, received intravenous antibiotics and underwent bioprosthetic aortic valve replacement with removal of all infected tissues. He returned 18 days later with severe dyspnoea, subjective fever and bilateral lower extremity oedema. Physical examination revealed tachypnoea and tachycardia without fever, prominent neck CV waves visible at 90°, left parasternal heave, 3/6 holosystolic murmur across the precordium, lung rales and severe peripheral oedema. C reactive protein was 211 mg/L (normal <8 mg/L). Blood cultures were obtained. ECG showed sinus tachycardia and right axis deviation. Transthoracic echocardiogram (TTE) parasternal zoomed short-axis systolic frame (figure 1A, B), apical four-chamber systolic frame (figure 1C) and subcostal continuous wave (CW) Doppler (figure 1D), are shown.

QUESTION

Given the clinical presentation and TTE findings, what is the diagnosis?Severe tricuspid regurgitation due to extension of endocarditisAortic valve obstruction resulting in severe pulmonary hypertensionAcquired Gerbode defectAortic valve dehiscence with severe paraprosthetic regurgitation.

Authors+Show Affiliations

Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.

Pub Type(s)

Case Reports
Journal Article
Video-Audio Media

Language

eng

PubMed ID

27634410

Citation

Sims, Jason R., et al. "Postoperative Dyspnoea." Heart (British Cardiac Society), vol. 103, no. 5, 2017, p. 367.
Sims JR, Enriquez-Sarano M, Michelena HI. Postoperative dyspnoea. Heart. 2017;103(5):367.
Sims, J. R., Enriquez-Sarano, M., & Michelena, H. I. (2017). Postoperative dyspnoea. Heart (British Cardiac Society), 103(5), p. 367. doi:10.1136/heartjnl-2016-310204.
Sims JR, Enriquez-Sarano M, Michelena HI. Postoperative Dyspnoea. Heart. 2017;103(5):367. PubMed PMID: 27634410.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Postoperative dyspnoea. AU - Sims,Jason R, AU - Enriquez-Sarano,Maurice, AU - Michelena,Hector I, Y1 - 2016/09/15/ PY - 2016/06/21/received PY - 2016/08/08/revised PY - 2016/08/22/accepted PY - 2016/9/17/pubmed PY - 2017/7/25/medline PY - 2016/9/17/entrez SP - 367 EP - 367 JF - Heart (British Cardiac Society) JO - Heart VL - 103 IS - 5 N2 - CLINICAL INTRODUCTION: A man in his 50s presented with abscessed aortic valve methicillin-sensitive Staphylococcus aureus endocarditis, received intravenous antibiotics and underwent bioprosthetic aortic valve replacement with removal of all infected tissues. He returned 18 days later with severe dyspnoea, subjective fever and bilateral lower extremity oedema. Physical examination revealed tachypnoea and tachycardia without fever, prominent neck CV waves visible at 90°, left parasternal heave, 3/6 holosystolic murmur across the precordium, lung rales and severe peripheral oedema. C reactive protein was 211 mg/L (normal <8 mg/L). Blood cultures were obtained. ECG showed sinus tachycardia and right axis deviation. Transthoracic echocardiogram (TTE) parasternal zoomed short-axis systolic frame (figure 1A, B), apical four-chamber systolic frame (figure 1C) and subcostal continuous wave (CW) Doppler (figure 1D), are shown. QUESTION: Given the clinical presentation and TTE findings, what is the diagnosis?Severe tricuspid regurgitation due to extension of endocarditisAortic valve obstruction resulting in severe pulmonary hypertensionAcquired Gerbode defectAortic valve dehiscence with severe paraprosthetic regurgitation. SN - 1468-201X UR - https://www.unboundmedicine.com/medline/citation/27634410/Postoperative_dyspnoea L2 - http://heart.bmj.com/cgi/pmidlookup?view=long&amp;pmid=27634410 DB - PRIME DP - Unbound Medicine ER -